|
PROFORMA
'C'
Pre receipted claim for "on account" payment
(To be submitted
in duplicate separately for imported & indigenous
fertilizers together with proforma 'A')
| Authority No. |
Ministry
of Chemicals & Fertilizers (Department of
Fertilizers) letter No._______________ dated______ |
Bill No._______________
|
|
Date
________________ |
State / UT ____________
Month to which relates__________
Name of the Claimant with full address_______________
Details of the Claim
| S. No. |
Product |
Net quantity
sold as per col. 6 of the Proforma A (MT) |
Rate of
Concession (Rs./MT)
|
Amount
of Concession (Rs.)
|
80%
of the amount now claimed |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| 1 |
IMPORTED DAP |
|
|
|
|
| 2 |
MOP |
|
|
|
|
| 3 |
INDIGENOUS
DAP |
|
|
|
|
| 4 |
COMPLEXES |
|
|
|
|
| 5 |
SSP |
|
|
|
|
| |
Total |
|
|
|
|
Total amount claimed being rounded
off Rs._________ (Rupees______________________________________________
)
1.
Certified that the quantity shown in the column 6
of the proforma 'A' on which concession is being claimed
is on net weight basis and does not include the weight
of bags. It is further certified that this quantity
of fertilizers has been sold on net weight basis and
exclusively for agriculture use and not for industrial
or any other use.
2.
Certified that the, sales claimed are
the actual sales made by the company during the month
and does not include stock transfer or sales on consignment
basis.
3.
Certified that all the conditions prescribed in the
Ministry of Chemicals & Fertilizers (Department
of Fertilizers) letter No.____________________ dated
______________ have been fulfilled.
Signature of the claimant
(With name, date, designation & Stamp)
Received Rs._____________(Rupees_____________________________________
)
Revenue Stamp
Signature of the claimant
(With name, date, designation & Stamp)
Please pay by crediting our current/CC
Account No.________ with State Bank of Patiala, Shastri
Bhawan, New Delhi.
Signature of the claimant
(With name, date, designation & Stamp)
To
ED, FICC, 8th Floor, Sewa Bhawan,
R K Puram, New Delhi. /
Director of Account, Department of Fertilizers, 4th
Floor Super Bazar, Connaught Circus, New Delhi.
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