Form T.R. 37-A
(See Note below Rule 366)
Bill for withdrawing Death-cum-Retirement Gratuity
Head of A/c “2071 Pension” District :
& other retirement Voucher No. :
Benefits gratuities List of payments for : As per authority attached
Name of Gratuitant : ________________________________________No. & date of letter of authority of the pay& Account office _______________ dt. _______________ P. P. O. No.: ______________________________.
Amount (Rs.)
Death-cum-Retirement Gratuity (Gross) _________________
Less deduction
Withheld amount _________________
Recovery towards Account _________________
Total deduction _________________
Net amount payable _________________
Net amount required for payment (in words) _______________________________________
Pay Rs. ______________ Signature: ________________________
(Rs. _____________________________ Designation_______________________
________________________________ Station ___________________________
Dated: ___________________________
Treasury Officer Contents received Pay to Shri/Smt.
Examined & entered _________________________________
Treasury Accountant Signature of DDO
For use in pay & accounts office.
Admitted for Rs. ________________
Objected to Rs. _________________
Nature of Objection______________
Auditor Superintendent Gazetted officer
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