GOVERNMENT OF KERALA GOVERNMENT OF KERALA GOVERNMENT OF KERALA

CHALAN ORIGINAL CHALAN ORIGINAL CHALAN ORIGINAL

FORM T. R. 12 FORM T. R. 12 FORM T. R. 12
[See Rules 102(c)and 124 of Kerala Treasury Code] [See Rules 102(c)and 124 of Kerala Treasury Code] [See Rules 102(c)and 124 of Kerala Treasury Code]
Chalan for Payment of Money into the Chalan for Payment of Money into the Chalan for Payment of Money into the
District Treasury/Sub-Treasury/State Bank of Travancore District Treasury/Sub-Treasury/State Bank of Travancore District Treasury/Sub-Treasury/State Bank of Travancore
At. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . At. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . At. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Computer Seq. No. Date : Computer Seq. No. Date : Computer Seq. No. Date :

Head of Account Head of Account Head of Account

Maj Smj Min Sub Det Obj S.Obj Maj Smj Min Sub Det Obj S.Obj Maj Smj Min Sub Det Obj S.Obj

DDO Code: (DDO) DDO Code: (DDO) DDO Code: (DDO)

Dept. Dept. Dept.

SDO Code: SDO Code: SDO Code:

By whom paid & By whom paid & By whom paid &

Purpose of Purpose of Purpose of
Name & address of Amount Order to the Name & address of Amount Order to the Name & address of Amount Order to the
remittance & remittance & remittance &
the person on whose Bank the person on whose Bank the person on whose Bank
authority, if any authority, if any authority, if any
behalf money is paid behalf money is paid behalf money is paid
Rs. Ps. Rs. Ps. Rs. Ps.

Correct Correct Correct

Receive and Receive and Receive and

grant receipt grant receipt grant receipt

Treasury Treasury Treasury

Officer Officer Officer

Signature & Signature & Signature &

Designation of the Designation of the Designation of the
Departmental Officer TOTAL Departmental Officer TOTAL Departmental Officer TOTAL
Counter signing the Counter signing the Counter signing the
remittance remittance remittance

Total in words: .............................................................................................................. Total in words: .............................................................................................................. Total in words: ..............................................................................................................

Signature of Remitter: Signature of Remitter: Signature of Remitter:

Received Rs. ......................................... Received Rs. ......................................... Received Rs. .........................................

(Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . only) . . . . . . . . . . . . . . . . . . . only) . . . . . . . . . . . . . . only)

Date : ............../................/.................. Date : ............../................/.................. Date : ............../................/..................

Signature of Treasurer/Cashier (Seal) Treasury Officer/Bank Manager Signature of Treasurer/Cashier (Seal) Treasury Officer/Bank Manager Signature of Treasurer/Cashier (Seal) Treasury Officer/Bank Manager

Note: Note: Note:

1. The Seal/Stamp of the Treasury/Bank of Collection shall be affixed 1. The Seal/Stamp of the Treasury/Bank of Collection shall be affixed 1. The Seal/Stamp of the Treasury/Bank of Collection shall be affixed
2. If remittance is in official capacity (SDO/DDO), write corresponding code in the 2. If remittance is in official capacity (SDO/DDO), write corresponding code in the 2. If remittance is in official capacity (SDO/DDO), write corresponding code in the
column provided. column provided. column provided.
3. If loan repayment of SDO, write installment number in purpose column. 3. If loan repayment of SDO, write installment number in purpose column. 3. If loan repayment of SDO, write installment number in purpose column.

(P.T.O.) (P.T.O.) (P.T.O.)