MADRAS TREASURY CODE FORM NO.

40-A
[See Instruction 4(I) to (III) under Treasury Rule 17]

BILL FOR WITHDRAWAL FORM GENERAL AND OTHER PROVIDENT FUNDS (MADRAS)
District
.
Sub-Account
Voucher No.
State provident Fund
.
Provident Fund
Bill for withdrawing Final payment/Temporary Advance/Other withdrawals from the
Provident fund of Sri.
_________________________for the month of

S.No.

Name and Designation of

subscriber

October 2014

Pay

D.P.Code

of

.
Branch
.
the establishment of th

D.O.Code
Nature of withdrawal

Fund Account
Number

Number and date of sanction letter of authority

Final Payments

Temporary
Advances

1)

Total . .
Deduct amounts short drawn in this bill . .
Net amount . .
Particulas of amount refundedS.No

Name of subscriber and

designation

Fund account
Number

Date of withdrawal

Particulars of amount
drawn

Amount now refunded

Net amount required for payment (Rs.

Rupees

Signature of Drawing officer________

Designation______________________
Total
Station

Contents Received

Please credit this bill amount through ECS in favour of

Date

Signature of Messenger________________

Signature__________________________________

hment of the office of

rawal
Others

Acquittance

yment (Rs.

)
.

er___________________
__________________

Remarks

2
1 Certified that I have satisfied myself that all sums included in bills (Form No.40A), drawn one month/two months/three months previous to this date favour
of
Account No.
with exception of those detailed* (of which the total has been been
efunded by deduction in this bill) have disbursed to the proper persons and that their "acquittances" have been taken and filed in my office with for every payment
receipt stamps duly cancelled in excessof Rs.20.
my credit
on the date of withdrawal covers the sum drawn in the bill.
2 Certified that the balance in the fund at
at the credit of the subscriber
3 Cetified that the policy/policies detailed below has/have already been assigned in favour of the Governor of Tamil Nadu and forwarded to the Accounts Officer
for safe custody/the details of the policy/policies proposed to be taken up have been communicated to and accepted by the Accounts Officer in his letter
No.____________________dated___________________________
Certificates:
1.Certified that this amount has not been
Name of the subscriber with provident fund
S.No
Number of policy
Name of company
Account of premium
drawn and paid previously.
account number
[1]
[2]
[3]
[4]
[5]
2.Certified that the interval between last
temporary advance sanctioned and present
1
temporary advance sanctioned is not less
2
than Six months.
3

4
5
4 Certified that In respect of withdrawals made in bills (Form No.40-A), one month/two months/three months previous to this date towards payment of Insurance

forwarded to the Accountant General,Madras

duly produced by me
for scrutiny with the exception to those relating to________________________for Rs.____________________________ and that necessary endorsements have been
made on the receipts to the effect that no abatement of income- tax is admissible.
5 (a) Certified that the number of policies financed from the Provident Fund does not exceed four.
Signature___________________
5 (b) Or Certified that the number of policies financed from the Provident Fund, which exceed four were already
accepted prior to 21st October 1953
Pay Rs.____________________
6 (a) Certified that this amount drawn in this bill is for payment of the premium to take up a fresh policy.
(Rupees_______________
(b) Certified that the policy is/policies are In full force and free from encumbrance.
Treasury
Examined and Entered
Accountant
Accounts
For use In Audit Office
Details of objection ,if any.
Rs.
Item___________________of__________________
Premia, the original premia receipt have been within one month of the date of withdrawal

Admitted

..

Objected

..

Total

..

NOTE:-

Auditor

Accountant

*The bills for withdrawal of advances/final withdrawal should be supported by a duly certified copy of the sanction in the proper from the letter of authority issued by the Audit Office
In case of non-gazetted Government Servants. The copy should be attested by the Head of the Office
In case of bills for withdrawal for payment of insurance premia reference to the letter of authority issued by the Audit Officer permitting the withdrawal should be quoted as also
reference to this stock number alloted to the policy assigned in favour of the Governor of Tamil Nadu and sent to the Audit Officer for safe custody
Certificate 5 (a) or 5 (b) may be retained according as the number of policies does not exceeds or exceed four in each individual case
The drawing officers should not present and Treasury Officers should not honour the bills in respect of claims made after the expiry of the period of grace allowed from the due date

for payment of premium specified in the statement below the certificate (2). The period of grace should invariably be mentioned in the bill.

T. N. T. C. 40-A

Due date of
Premium
[6]

Stock number
[7]

Madras

_________________________

_____________________
______________________________)
Officer

n ,if any.