ANDHRA PRADESH TREASURY CODE FORM No.40-A (See instructions 4(i) to (iii) under Treasury rule 17.) BILL FOR WITHDRAWAL FROM GENERAL AND OTHER PROVIDENT FUNDS (ANDHRA PRADESH) ANNEXURE District: Sub-Account_____________________ Voucher NO._______________ of ______________20. State Provident Fund_________________ Provident Fund _____________________________ __________________Branch. Bill for withdrawing in the office of Final payment Sri Advance from the ______________________ Provident Fund of _______________________________________ Other withdrawals the establishment of _______________________________________ for the month of ________________________ Serial Number Name and designation of Subscriber. Pay Fund Account Number No. & date of Sanction Of _____ letter authority Nature of withdrawal Acquittance Remarks Final payment s Advance s Others Total Deduction amounts shortdrawn in this bill Net Amount Particulars of amounts refunded: - Serial Number Name of Subscriber & Designation Fund Account Number Date of Drawl Total Particulars of amount Drawn Amount now refund Net amount required for payment (Rs. ) Rupees Signature of Drawing Officer Designation Signature Station: Signature of Drawing Officer Date: Designation Contents received: Please pay to Signature Signature of messenger: Certified that I have satisfied myself that all sums included in bills (Form No. 40-A), drawn one month / two months / three months previous to this date in favour of Messers. ________________ Account No._______________________ with the exception of those detailed * (of which the total has been refunded by deduction in his bill have been disbursed to the proper persons) and that their acquittances have been taken and field in my office with receipt stamp duly cancelled for every payment in excess of Rs. 20 ________________ My credit 2. Certified that the balance in the fund at __________________________________ on the date of withdrawal covers the sum drawn in the bill. The credit of the subscriber Policy No._________________ with _____________________Co. 3. Certified that the _________________________________ have already been assigned in favour of the Governor of Andhra Pradesh and forwarded to the Accountant. The policies detailed below: - General, Andhra Pradesh , for safe custody / the details of the policy / policies proposed to be taken up have been communicated to and accepted by the Accountant General, Andhra Pradesh In his Letter No.__________________________ dated __________________________ 4. Certified that in respect of withdrawals made in bills (Form No. 40-A), one month /two months / three months previous of the date towards payment of the insurance forwarded to the Accountant-General, Andhra Pradesh. Premia the original premia receipt have be, within one month of the date of withdrawal _________________________ for scrutiny with the exception of those Serial Number Name of subscriber With fund Account Number No. of Policy Name of Company Amount of Premium Due date of Premium Stock Number 1. 2. 3. 4. 5. duly produced to me. Relating to __________________Rs. __________________ and that necessary endorsements have been made on the receipts to the effect that no abatement of income tax is admissible. Signature ____________________________ Pay Rs. ______________________________ (Rupees):_____________________________ Treasury ______________Officer Examined and entered Accountant Accounts For use in Audit Office Item _____________________of __________________ Details of objection, if any Rs. Admitted . . . Objected . . . _____________ Total . . . _____________ Auditor. Accountant Note: - The bills for withdrawal of advances/ final withdrawals should be supported by a duly certified coy of the sanction in proper forms/ the letter of authority issued by the Audit Officer. In the case of Non-Gazetted Government servants the copy should be attested by the head of the office. In the case of bills for withdrawal payment of Insurance premia reference to the letter of authority issued by the Audit Officer permitting the withdraw should be quoted as also reference to the stolk number allotted to the policy assigned in favour of the Governor of Andhra Pradesh and sent to the Audit Office for safe custody.
