Enclosure to Corrigendum no 232, Dt: in respect of order no: 215/FIN/IPC/449, Dated: 12-05-2020

Annexure-FA
Distributors’ Claim towards Transport Rebate and Commission Consequent upon Distribution of food grains Free of Cost w.e.f. _________ Vide GO No. ___________
Date:_______________________ for the month of APRIL-2021
Name of the scheme: OMSS WHEAT (T.G, RKSY-I, RKSY-II)
Name of the Distributor: _____________________________ Distributor’s licence Number: _________________________
Bank Account No. of the Distributor: _________________; Name of the Bank A/C Holder:______________________________; A/C Type: ________________; IFSC: _________________________; PAN:
_________________________ .
Sl Month Schem Opening FCI D.O. No. And Quantit Quantit Quantity Lifting Dista Applic TR Amt. Door Door Rate Commissi Total Closi
N e stock RO Date y as per y lifted delivere point nce able Step( Step TR of on Claim ng
o. No & D.O. d Free of cover T.R. 8 Amount Comm Amount Stock
date( Cost to ed Rate kms) ission
if FPS Per per
appli Quinta quinta
cable l l
A B C D E F G H I J K L M N O P Q R S
HxL HxN LxP M+O+Q D+H-l
1 APR RKSY-I 3858.65 - D-1449847
- - 761.40 NJP 140 88.80 67612.32 26.40 20100.96 18/- 13705.20 101418.48
2021 Wheat 02/02/21
D-00112
1500.00 1500.00 1500.00 ARDC/COB 22 35.76 53640.00 26.40 39600.00 18/- 27000.00 120240.00
02/03/21
D-00127
800.00 800.00 800.00 BBH/COB 22 35.76 28608.00 26.40 21120.00 18/- 14400.00 64128.00 NIL
23/03/21
D-00142
700.00 700.00 700.00 BBH/COB 22 35.76 25032.00 26.40 18480.00 18/- 12600.00 56112.00
06/04/21
D-00157
500.00 500.00 97.25 NJP 140 88.80 8635.80 26.40 2567.40 18/- 1750.50 12953.70
06/04/21
APR RKSY-II D-00157
2 373.75 - - - 373.75 NJP 140 88.80 33189.00 26.40 9867.00 18/- 6727.50 49783.50
2021 Wheat 06/04/21
APR SPA/C D-00157
3 29.00 - - - 29.00 NJP 140 88.80 2575.20 26.40 765.60 18/- 522.00 3862.80
2021 T.G 06/04/21
TOTAL-408498.48
Rs: 408498.48/-…… (in words) FOUR LAKH EIGHT THOUSAND FOUR HUNDRED NINTYEIGHT AND FORTY EIGHT PAISE ONLY.
Certified that:
1. The bill is not drawn before. Amount deposited by the distributor has been duly verified with relevant D.O. and found correct.
2. The bill has been checked with reference to D.O., quantity, rate and amount are found in order.
3. Proper noting has been made to avoid double payment.
4. Any amount if discovered being paid in excess shall be recovered forthwith in one lump.

Verified from Stock Book Signature of the Claimant with official seal

Inspector(F&S)/Designated Officer

Signature of Account Officer Signature of District Controller