ANNEXURE-C
Bill No. Receipted Bill Head of Account
Major Head ‘8011’ INSURANCE
Pension Fund U. T. Govt.,
Employees Group Insurance Scheme,
Insurance Panel Saving Panel._________
Received sum of Rs. ___________ (Rs. ______________________________________ ). The total of entitlement of Rs. ___________ from the Insurance Fund and/ or Rs. _________
Name: ________________________________________ Designation: _________________ * Group A – B – C – D under the Central Govt. Employees Group Scheme 1980.
Dated: Signature (Sig. of receiptent(s)
Name in Block Letter)
FOR USE IN DEPARTMENTAL OFFICE
a) Relevant Bio-Data of the Member.
1. Type of Group of the member (i.e. lowest group) viz. D/C/B/A on initially joining the Scheme on ______________.
2. Year of acquiring membership of higher group i) C 19________.
ii) B 19________.
iii) A 19________.
b) Countersigned for payment of Rs. __________ (Rs. _________________________ ) to claimant(s) crossed/Demand Draft to be issued in favour of Claimant(s) Sh./Smt. ___________________________________________________________________ .
Signature _______________________
Date: Designation _____________________
FOR USE IN ACCOUNTS OFFICE
Passed for payment for Rs. _______________ (Rs. ________________________________) through cheque(s).
ACCOUNTS OFFICER
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