FORM GFR 19-A

(See Government of India's Decision (1) below Rule 150)

FORM OF UTILISATION CERTIFICATE

Sl. Letter No. and date Amount

No. (Rs)
1 No. KSHEC/RUSA 2191556
FUND/2015-16/389
DATED 14/09/2015
2 No. KSHEC/RUSA 283444
FUND/2015-16/593
DATED 16/12/2015
3 No. KSHEC/RUSA 3236538
FUND/2015-16 DATED 02-
02-2016
TOTAL 5711538

1. Certified that out of Rs 5711538 grants-in-aid sanctioned during the year 2015-
2016 Under RUSA under the Letter No’s mentioned in the table above, a sum of
Rs…………………… only has been utilized for which it was sanctioned and that the
balance of Rs………………… remaining unutilized as on 30th June 2016

02. Certified that I have satisfied myself that the conditions on which the grants-in-aid
was sanctioned have been duly / are being fulfilled and that I have exercised the
following check to see that the money was actually utilized for the purpose for which it was
sanctioned.

03. Kinds of Cheques exercised.

SL.NO. CHEQUE NO. WITH DATE AMOUNT NAME OF

(RS.) VENDOR
& PURPOSE
1.
2.
3.
4.

.
Signature :
Designation :
Date :