Month

Name
DESIGN.
Audit No.
PAN
INCOME TAX
No. of Nights
Rate per Night
Electricity Charge

JANUARY
DINESH KUMAR
ASSTT. ENGINEER
D-XXXX
0

1012

2016

U. P. POWER CORPORATION LTD.

FORM No. 5 F.H.B. VOL. V PART I
(See Chapter VI Article 108)
NOTE:

Government accepts no responsibilitiy for nay fraud of misappropriation in respect of money or cheque of bills
made over to a messanger.
Name of Gazetted Government Servan

DINESH KUMAR

District : MEERUT

PAY BILL

Audit No.

1. Major head..
2. Minor head.
3. Primary & Secondary Unit
appropriation..

Voted
Charged

Received for the month of ...... JANUARY

2016

D-XXXX

Voucher No.
List of Payment

For..
My substantive pay as
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)

ASSTT. ENGINEER

Pay
Special Pay
Dearness allowance
Medical Allowance
House Rent Allowance
C.C.A.
E.S.A.
Grade pay
.
Night Shift Allowance

Fill Departmen here

DEDUCTION :G.P.F. A/c. No. BB/O

G.P.F. Advance A/c. No. BB/O
House Bldg. Advance
House rent for the month of
Car/Scooter Advance
Electricity charges + Electricity duty
Income Tax
0

Monthly Rate
Amount
Rs.
P. Rs.
P.

Gross Total

15600.00
0.00
24990.00
200.00
0.00
360.00
450.00
5400.00
0.00
0.00

Inst. No.

Total deduction & recovery

Net amount payable

15600.00
0.00
24990.00
200.00
0.00
360.00
450.00
5400.00
0.00
0.00
47000.00

1012.00
0.00

1012.00
45988.00

Net amount to be written in the hand writing of the officer

(Rupees ..)
Please pay to.......
The....
Received Payment

Signature
PAYEE'S DISCHARGE
Name
:
Designation :
Office
:

Signature of Officer
DINESH KUMAR
ASSTT. ENGINEER
ALDS MODIPURAM, MEERUT

U. P. POWER CORPORATION LTD.

FORM No. 5 F.H.B. VOL. V PART I
(See Chapter VI Article 108)
NOTE:

Government accepts no responsibilitiy for nay fraud of misappropriation in respect of money or cheque of bills
made over to a messanger.
Name of Gazetted Government Servant
District :

PAY BILL

Audit No.

1. Major head..
2. Minor head.
3. Primary & Secondary Unit
appropriation..

Voted
Charged

Voucher No.
List of Payment

For..
Received for the month of ......

Monthly Rate
Amount
Rs.
P. Rs.
P.

My substantive pay as
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
(xi)

Pay
Special Pay
Dearness allowance
Medical Allowance
House Rent Allowance
C.C.A.
E.S.A.
Grade pay
.
Night Shift Allowance

DEDUCTION :G.P.F. A/c. No. BB/O

G.P.F. Advance A/c. No. BB/O
House Bldg. Advance
House rent for the month of
Car/Scooter Advance
Electricity charges + Electricity duty
Income Tax

Gross Total

Inst. No.

Total deduction & recovery

Net amount payable
Net amount to be written in the hand writing of the officer
(Rupees ..)
Please pay to.......
The....
Received Payment

Signature
PAYEE'S DISCHARGE
Name
:
Designation :
Office
:

Signature of Officer