TO BE PAID THROUGH SYSTEM ONLY

PFMS Generated Print Payment Advice

Approval date in PFMS: 22 Mar 2020 Payment Advice No.: C032029368391
Expiry date of PPA PFMS: 01 Apr 2020 Advice Print Date : 22 Mar 2020
PAN No. : TAN No.:
Note For Branch:
Contact Details BANK PFMS
Name: MR. BISWA PRAKASH SAHOO
Email : hodpnd.ugb@gmail.com Helpdesk-pfms@gov.in
Phone No. : 8763451923 011-23343860
To,
Note:
The Branch Head
UTKAL GRAMEEN BANK
MALKANGIRI Branch

We authorise the bank to debit our undernoted account maintained with the bank with batch
amount and credit the beneficiary(ies) [#8] as per ANNEXURE-I uploaded to bank's central
system through PFMS O/o CGA.

Bank Account No. 84007409272 Total Amount of Debit : Rs 1,10,000.00

(Amount in words : One Lakhs Ten Thousand )
Batch No. C032029368391
No. Of Beneficiaries as per Annexure-I.

Agency Seal
.................................................. ..................................................
(Sign by Authorized Signatory) (Sign by Authorized Signatory)
Name - Name -
__________________________ __________________________
Designation - Designation -
____________________ ____________________
Mobile No - Mobile No -
______________________ ______________________

To,
SCA CUM PIA PODIA BLOCK-[ORML00003772]
Ref: Account No. 84007409272
Payment Advice Number C032029368391

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We confirm having received the captioned advice of credit(s) for payment today for further processing as
per arrangement of bank on integrated PFMS-Bank payment system.
No. Of Beneficiaries : 8 Amount (in Rs.) : 1,10,000.00
Date & Time :

UTKAL GRAMEEN BANK Branch Seal Branch Authorized Official

Agency to enter date of delivery in PFMS using option | E-Payment => PPA Submission Status

ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C032029368391

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
1 BHIMASEN C032029368366 xxxxxxxxxxxx8818 ANDB0002030 13,750.00
MADKAMI
2 BIJAY KU MADI C032029368362 xxxxxxxxxxxx1628 ANDB0002030 13,750.00
3 BRAJ KISHOR C032029368364 xxxxxxxxxxxx2421 ANDB0002030 13,750.00
KABASI
4 C032029368365 xxxxxxxxxxxx5438 SBIN0001325 13,750.00
DASARATHBATA
5 ISWAR C032029368363 xxxxxxxxxxxx9718 ANDB0002030 13,750.00
PODIAMI
6 NAKA DHARMA C032029368361 xxxxxxxxxxxx5255 ANDB0002030 13,750.00
RAJU
7 NAKA RABI C032029368360 xxxxxxxxxxxx0469 ANDB0002030 13,750.00
KUMAR
8 SAJANRAJU C032029368359 xxxxxxxxxxxx6612 ANDB0002030 13,750.00
NAKA
Total Amount(Rs) 1,10,000.00

Please acknowledge and do the needful as prescribed by bank to complete transactions.

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