Form75APTC FORM -75/76( PENSIONER'S BILL )FOR THE MONTH OFNAME OF THE PENSIONER:Date:P.P.O. Number:Trans ID:Treasury/PAO CODE1504Major HeadDDO Code:15040308002Sub Major HeadDDO Designation:M.E.O HUSNABADMinor HeadDDO Office Name:MRC- HUSNABADGroup Sub HeadBank Branch Code:21135Sub HeadBank NameSTATE BANK OF HYDERABADDetailed HeadBank Branch Name:HUSNABADSub Detaied HeadNon-Plan=N/Charged=C/Contigeny Fund MH/Plan=PVoted=VService Major HeadReceived the amount of my pension for the month andn year :0.00Pension :0.00D.R.0.00Arrears Rs.0.00Gross Total Rs.0.00Less: 1.Recoveries if Any Rs.2.Income Tax Rs.Net Rs.0.00Net Rupees :Rupees NilDate:Thumbs Impression or Pensioner,s SignatureFOR USE IN TREASURY/PAY & ACCOUNTS OFFICE ONLYPay Rs :Rupees Nilby cash / Cheque / Draft / Account Credit as under and Rs.......(Rupees..........only by adjustment.)Treasury Officer/Pay& Accounts Officer(P.T.O)CERTIFICATE ON NON- EMPLOYMENT(To be signed by all pensioners expect ex-interior servants and ex-policemen who are in receipt of a pension of not more than Rs. 10 per monsoon)I declare that I have received any remuneration for serving in any capacity either in a Government establishment or any establishment paid from a Local Fund during the period for which pension claimed in this bill due the amount of Pension Claimed till this bill is due.Note : The term "Local Fund" means in this certificateany of the District Muncipal or Panchayat Funds Educational funds.Port and Marine Funds etc.mentionedin instruction 2 in Chapter IV in Part III and also any "Local Fund" under the control of Central Government.Signature of the PensionerPlease pay net amount of the bill to:or Left Thumb Impression(For use in Accountant -General's Office)Admitted:Objected:Total:Date:AuditorSuperintendentSingnate of pensioner / Left Thumb ImpressionLIFE CERTIFICATECertificate that the pensioner named in this bill is alive this day,the ..day of ....20. and has signed in my presence this bill and above request for payment to a messenger.Signature of the Pensioneror Left Thumb ImpressionStation :Signature:Date :Designation:Received Contents"Signature of the Pensioneror Left Thumb Impression

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