, lh th&17 Hkkjrh; Mkd&rkj foHkkx

A.C.G.-17 Indian Posts And Telegraphs Department

[Mkd&rkj forh; fu;e iqfLrdk ( [k.M 1 f}rh; laLdj.k nwljk iqueZn.z k ifjf”’B 11 ds fu;e 6 [k ds uhps dh
fVIi.kh ns[ksa ]
[See Note below Rule 6(b) of Appendix II to Posts and Telegraphs Financial Handbook,
Volume I (2nd Edition, 2nd Reprint)]

jlhn/Receipt

rkjh[k ___________19 okmpj la_______________________

Date____________19 Voucher No.

Received from ___________________ls the sum of Rupees

__________________

________________________________________________________________: dh
jkf”k

_______________________________________________________________on
account

of__________________________________________________________ds dkj.k izkIr

dh

:/Rs_________________________
xokgh”kqnk Hkqxrku /Witnessed Payment

xokg ds gLrk{j ikus okys ds gLrk{j

Signature of witness Signature of payee
fVii.kh&;fn jlhn dks vaxt sz h@ fgUnh es u fy[kk x;k gks ;k ml ij vaxt sz h@ fgUnh es gLrk{j
u fd;s x, gksa rks ml lEiw.kZ dks ;k mlds fdlh Hkkx df tks vaxt sz h@ fgUnh es u gks Hkqxrku djus okyk vf/kdkjh
mldk fyI;arj.k djs ! tks O;fDr bl jlhn ij fgUnh es gLrk{j djs mls vius gLrk{jksa ds uhps dks’Bd es Li’V
v{kjksa es viuk uke fy[kuk pkfg, !
Note:- If the receipt be not written or not signed in English/Hindi the whole or
the portion not in English/Hindi must be transliterated by the paying officer. A person
signing such receipt in Hindi should be required to indicate his full name in block letters
within brackets below his signature.
ftl O;fDr dks Hkqxrku fd;k tk, ;fn og gLrk{j ugh dj ldrk rks Hkqxrku djus okyk
vf/kdkjh ml Hkqxrku dks izekf.kr djs rFkk mlds fy, de ls de ,d xokg gks !
If the person paid cannot sign, the payment must be certified by the Paying
Officer and at least one witness.
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 ;fn Hkqxrku dh xbZ jde 20 : ls vf/kd gks rks chl iSls dk jlhnh fVdV yxkuk pkfg, vkSj
bl fVdV dk Hkqxrku ikus okys dks djuk pkfg, !
If the amount paid be more than Rs.20/- a receipt-stamp of Twenty Paise must be
affixed and this stamp must be paid by the person to whom the amount of receipt is paid.
1. izekf.kr fd;k tkrk gS fd okmpj es
vafdr jde lgh O;fDr dks laforfjr dj nh xbZ gS
!
1.Certified that the amount included in the voucher has been disbursed to the proper
person.

Hkqxrku deZpkjh izfrgLrk{kfjr laforj.k vf/kdkjh

Paying Official Countersigned Disbursing Officer

2 dkxtkr izkIr gq, vkSj ;g izekf.kr fd;k tkrk gS fd eS Lo;a mlls lar’q V gks x;k gwa fd mu vfxzeks
dks NksMdj ftudk C;ksjk ( ftldk ;ksx bl jlhn ls okil dj fn;k x;k gS ) uhps fn;k gS vkt dh rkjh[k ls
iwoZ 1 eghuk@ 2 eghus@ 3 eghus es fudkys x, jlhn QkeZ , lh th&12 es fn, x, lHkh vfxzeks dk lgh
O;fDr;ksa dks Hkqxrku dj fn;k x;k gS vkSj muds osru fpVzBs ls fy, x, gSa vkSj 20@: ls vf/kd ds izR;sd
Hkqxrku ds fy, jlhnh fVdV fof/kor jn djds esjs dk;kZy; es QkbZy dj fn, gSa !
2. Received contents and certified that I have satisfied myself that all advances
included in receipt form A.C.G.-17 drawn 1 month/2 months/3 months previous to this date
with the exception of those detailed below (of which the total has been refunded from this
receipt) have been disbursed to the proper persons and that their acquittances have been taken
and filed in my office with the receipt stamps duly cancelled for every payment in excess of
Rs.20/-.

rkjh[k laforj.k vf/kdkjh

Date Disbursing Officer.

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