DATASHEET for Statutory Audit of RKS 2023-24

Name of the Public Trust (RKS)

Name Unit :

Name of Block :

Name District:

Registration No. of RKS:MAH/ /

F Number :
RECEIPT Rs. Rs. PAYMENT Rs. Rs.
To Opening Balance 0.00 By Expenditure in respect of properties :-
Cash Rates, Taxes, Cesses
Bank 0.00 Repairs & Maintenance
Depreciation/other
To Opening Balance Advance Bank Charges
To Interest (accrued/realised) 0.00 Other
By Expenses of sub - centre 0.00
on Securities By NRHM Expenses 0.00
Add:-Mo Anamat By Remuneration to Trustees
By Advance to M.O.( F.P./ JSY)
On Bank Account 0.00 By Legal Expenses
On bank Account (IPHS) By Other Payments/ Transfers/ Expenditure
To Dividend Loan from MO/ others 0.00
Transfer to NHM funds 0.00
To Donations in Cash or Kind By Expenditure on Objects of the Trust
(a) Medical Relief
1. Rugna Kalyan Samiti 0.00
To Grants Received 0.00 Purchases (fixed Assets) 0.00
Medicine/Cloth Purchases, (other) 0.00
Rugna Kalyan Grant 0.00 Printing & Stationery 0.00
Repair & Maintainance,Conti./Telephone Charges etc. 0.00
contingency 0.00
Annual Maintenance Grant 0.00 Audit fees 0.00
other 0.00
Untied Fund 0.00 2. Annual Maintenance 0.00
Purchases (fixed Assets) 0.00
Wages & Honorioum (Others) 0.00
IPHS GRANT PHC Printing & Stationery 0.00
Repairs & Maintenance / Telephone Charges 0.00
IPHS Grant SC contingency, Packing Stat. Electricity Charges, etc.. 0.00
IPHS/ RH/ SDH Vehicle repaired 0.00
To Other Receipts 0.00 other 0.00
OPD Fees 0.00 3. Untied Fund 0.00
Other's Grant 0.00 Purchases (fixed Assets) 0.00
Lab Fee 0.00 Purchases (other) 0.00
Uncleared cheques reversed 0.00 Maintenance 0.00
NRHM receipts routed through RKS 0.00 contingency 0.00

Commission Coin Box 0.00 4. OPD 0.00

Received - kayakalp Advance 0.00 Purchases (fixed Assets) 0.00

For Account Opening) 0.00 Medicine/Cloth Purchases (other) 0.00
To Anamat 0.00 Repairs & Maintenance / Telephone Charges 0.00
Anamat (MO) 0.00 5. IPHS SC 0.00
Prior Period Receipt 0.00 Purchases (fixed Assets) 0.00
To Transfer from Reserves 0.00 Medicine & Cloth Purchases 0.00
Wages & Honorioum 0.00
Contingency,Stat.Traveling,Xerox,etc. 0.00

Grant refund/ANAMAT Refund 0.00

MO/MS 0.00
THO/DHO 0.00

Bank charges 0.00 0.00

By Closing Balance
Cash In Hand
Cash At Bank 0.00 0.00
0.00 0.00 0.00 0.00

# Total of the datasheet should tally (matched).

## All Units are required to fill it correctly as this would be checked with the cash book by the auditor.
Other Details:
1. Auditee Name:
2. Accountant Name & Contact Number:
3. THO Name & Contact Number:
4. Previous RKS Audit Report Copy:

Signature of Chairman / Member Secretary of RKS

 NAME OF THE TRUST/PHC :-
NAME OF THE BLOCK :-
RKS Registration No.MAH/ /
F Number :

Schedule of Fixed Assets

As on 31.3.2024

Opening Sale/ Scrap Closing

Addition During
Sr. No. Particulars Balance as on during the Balance as on
the Year
01-Apr-23 year 31-Mar-24

1 2 3 4(1+2-3)
Amount in Rupees Amount in Rupees Amount in Rupees Amount in Rupees
1 0 0 0 0
2 0 0 0 0
3 0 0 0 0
4 0 0 0 0
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

TOTAL 0 0 0 0

Signature of Chairman / Member Secretary of RKS

 Bank Reconciliation Statement as on 31-03-2024
Name of Bank and Account No.
Balance as per Cash Book 0 0
Add: Chq issued but not cleared 0
Add: Intt given by bank, not entered 0
Less: Chq deposited but not cleared 0
Less: Charges by bank, not entered 0
Add/Less: Old Differences 0
Balance as per Bank Pass Book 0 0

Details of Cheques Issued but not Cleared Details of Cheque Deposited but not
cleared

PFMS No Date Amount Cheque No. Date Amount

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
TOTAL 0 TOTAL 0

Signature of Chairman / Member Secretary of RKS

NAME OF THE TRUST/PHC :-
NAME OF THE BLOCK :-
Year-2023-24
RKS Registration No.MAH/ /
F Number :
Details of Meetings conducted
A) Meetings of RKS Date of Meeting Members Present
a) Minutes of Meeting (Executive Body)
Meeting No.1
Meeting No.
Meeting No.
Meeting No.
Meeting No.
Meeting No.

b) Minutes of Meeting ( Governing Body)

Meeting No.1
Meeting No.
Meeting No.
Meeting No.

-------------------------------------
Signature of Chairman / Member Secretary of RKS
NAME OF THE TRUST/PHC :-
NAME OF THE BLOCK :-
Year-2023-24
RKS Registration No.MAH/ /
F Number :
MEMBERS OF GOVERNING COMMITTEE
Sr. No. Name of Members(RKS) Designation

1 Chairman
2 Vice Chairman
3 Member
4 Member
5 Member
6 Member
7 Member
8 Member
9 Member
10 Member
11 Member
12 Member
13 Member

Signature of Chairman / Member Secretary of RKS

NAME OF THE TRUST/PHC :-
NAME OF THE BLOCK :-
Year-2023-24
RKS Registration No.MAH/ /
F Number :

MEMBERS OF EXECUTIVE COMMITTEE

Sr. No. Name of Members(RKS) Designation

1 Chairman
2 Member
3 Member
4 Member
5 Member
6 Member

Signature of Chairman / Member Secretary of RKS

NAME OF THE TRUST/PHC :-
Name of Block -
Year-2023-24
RKS Registration No.MAH/ /
F Number :

Schedule of Cash & Bank Balance AS ON 31/03/2022

Opening Balance as on Closing Balance as
Sr.
Particular of Bank / Cash 01.04.2023 On 31/03/2024
No.
Cash Bank Cash Bank
A RKS - 0.00
B Annual Maintenance Grant - 0.00
C Untied fund - 0.00
D Others - 0.00
E OPD/IPD 0.00
Total 0.00 0.00

Signature of Chairman / Member Secretary of RKS

NAME OF THE TRUST/PHC :-
NAME OF THE BLOCK :-
Year-2023-24
RKS Registration No.MAH/ /
F Number :

Status of Advances as on 31.3.2024

Sr. No. Name to whom Opening Given Reported Recovered Closing
advance is given Balance as on advance Expenditure against advance Balance as on
01/04/2023 advance 31/03/2024

1 2 3 4 5 6 7=(3+4-5-6)
1
2
3
4
5
6

Signature of Chairman / Member Secretary of RKS

 Details of Expenditure Under RKS
Name of the Description of
Date Voucher No Party Expenditure Amt

0
 Details of Expenditure Under RKS
Description of
Date Voucher No Name of the Party Expenditure Amt

0
 Details of Expenditure Under UF
Description of
Date Voucher No Particulars Expenditure Amt

0
 Details of Expenditure Under IPHS
Description of
Date Voucher No Particulars Expenditure Amt