I.A.F.

A-498(Large)
LOSS STATEMENT-ALL SERVICES
(See Regulations for the Army in India Equipment Regulations, Part-I and Financial Regulations, Parts I and II)
(This form will be used in cases of losses of stores of public money or regularization of irrecoverable debtor balances of non-
effective personnel)
Description of property (in case Date Date of Reason for non recovery at Amount of debtor balance Remarks
of stores, then quantity or No. of discover the time of release/discharge /loss Reasons for
and in the case of Ordnance issue y of for delay if
stores the vocabulary section in or loss/deb Conditio Stock Value Value of Value of any, in
addition) and the circumstances receipt tor n of book of reconditi articles lost, detecting
under which deficient, damaged of balance stores, Rate. Article oned vide the debtor
or destroyed stores equipme before articles instructions balance/loss
N.B:- in the case of wastage the nt, etc at conditi on the reverse
period of the storage must be the time oning
stated. of loss

Notes:-
(1) While using the form for regularization of Irrevocable debtor balances of non-effective personnel Imprest losses, Cols.4,
5 and 6 would become one column and cols.7 and 8 would also become one column.
(2) Give particulars of Imprest A/c No./Army/I.O.No., Rank/Name/Designation of soldier/Person in Col.I in the case of
cash losses/Dr.in IRL As.
(i) Certified that IRLA of the individual shows a Dr.balance of Rs…………………………………. CFA’s sanction is
required to regularise the loss.(the value of the loss has been assessed according to the facts mentioned in the loss
statement)

Station:……………………….. Signature…………………………...
Date………………………….. Designation…………………………
(of the OC/UA/PAO, etc., assessing the value of the loss statement)
(ii) Certified that number/quantity lost as shown above has been struck off in ………………………………………(the
name of the store ledger)for the month of……………………20……..

Officer Commanding……………………………
(/Name of the unit or formation)

(iii) Certified that :-

The recovery write-off of the sum of ………………………… has been/will be made in the IRLA /Pay Accounts
for the month of ……………………20…..

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The sum of ……………………….. has been credited into……………………….treasury, vide treasury Receipt
No……………dated………………………Imprest A/c No………………………..for the month
of………………….20…….

OC/PAO/UA………………………………………………. (Name of the Unit or Formation)

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*Strike out whichever is not applicable.