DEPARTMENT OF POSTS – INDIA

A.C.G.-17

The ..................... of .......................................

Received from the Post Master, Baripada H.O.
The sum of Rs.....................(.........................................................................................................) only
On account of delivered by the Speed Post and EPP by Postman No....................... and beat No..........
for the month of .....................................

Signature of payee

Date: Delivered 31
Speed Post + EPP = Total Total
1
2
Checked and found correct
3
4
5
6 Signature of Speedpost Clerk
7
Checked and found correct
8
9
10
11 Signature of EPP Clerk
12
Checked and found correct
13
14
15
16 Signature of APM
17 Checked and found correct
18
19
20
21 Signature of Postmaster
22
23
24
25
26
27
28
29
30