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WBHS TR68C-32

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Nazimul Islam
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9 views

WBHS TR68C-32

Uploaded by

Nazimul Islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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T.R. FORM NO.

68C
[See G.O No.....Dated........]
(To be used for the sanction order generated from WBHS portal)
Medical charges for Reimbursement/ Advance/ Adjustment against Advance Bill under West Bengal Health Scheme
D.R. No: 202409024289915 Ref. No:

Name of the Office: BMOH, BISWANATHPUR BPHC


D.D.O Code: NPAHFH013 Bill No: 84 Date: 10/09/2024
Token No.: Date: T.V. No.: Date:
Head of Account: 24-2211-00-001-011-12-00-V

Claim Type: Reimbursement / Advance / Adjustment against Advance


Name of
Gross Net
Sl. Employee Name of Nature of HCO Name and Deduction
Claim Id Sanction No. Date Authority Amount Amount
No. / Beneficiary Treatment Address (Rs)
(Rs) (Rs)
Pensioner
BLOCK MEDICAL Indoor and Indoor FORTIS HOSPITALS LIMITED (
6HFHO43320241426
1 E20243016389 10/09/2024 OFFICER OF PUJA SINGH PUJA SINGH related OPD 730,ANANDAPUR, KOLKATA- 6624 0 6624
56440
HEALTH Treatment 700107 )
Total (Rs.) 6624 0 6624

Allotment Details 1. Certified that I have satisfied myself that the amount drawn previously, with the exception ofthese detailed above (of which the
total amount has been refunded by deduction from this bill)have been disbursed to the Government employee therein named
Allotment Received Rs. and then receipts taken in the office copies of the bill or in a separate acquaintance roll.
Progressive Rs. 2. Certified that Essentiality certificates, original Money receipts, Bills, Vouchers etc are appended.
expenditure 3. Certified that no claim for the period mentioned in this bill has been preferred earlier.
including this bill 4. Declaration has been obtained as to receipt/ non-receipt of Medical Insurance claim for the same treatment as appended above.
5. Claims have been included in this bill for drawl after sanction by appropriate authority as per Rule.
Balance available Rs.
Please Pay Rs. 6624 ( Rupees. Six Thousand Six Hundred and Twenty Four ) only as per beneficiary details available in digitized form.

And/Or
Please pay By-Transfer Credit Rs................. (In words) as below
Sl. No. Head of Account Description Amount (Rs.)

Bill Clerk Accountant Signature of D.D.O with Designation Station

Dated :

For use at the Treasury


Pay Rs. _________ Rupees (in words) ____________________________________________________ only as per beneficiary details available online.
By-Transfer Credit Rs. ___________ Rupees (in words) ______________________________________ only as below-
Sl. No. Head of Account Description BT Type Amount (Rs.)

Examined and Entered.

Accountant / J.A.O. T.O. / A.T.O. / P.A.O. / A.P.A.O.

For use in the Office of the Accountant General (Audit), West Bengal

Admitted Rs.___________________________________
Objected Rs. ___________________________________
Reasons for objections ___________________________

Auditor S.O / A.A.O. / Audit Officer

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