Scroll No. :_________________
(To be allotted by the Bank)
(To be filled in by the Depositor)
__________________________________________________________________
By whom tendered:__________________________________________________
Name and address of person with TIN on whose behalf money is deposited_____
District:___________________
Act under which payment made. Tick the relevant box.
Total [(i) to (v)] in words: ____________________________________________
______________________________________________________________________________
(To be filled in by the Treasury)
Treasury Code: ______________
DDO Code: _________________
Rs. ______
Received payment (in words)
Rupees__________________
as allotted by Treasury
(Ordering the money to be paid in)