|
PROFORMA
'D'
Proforma for claiming balance payment
(To be submitted
in duplicate separately for imported & indigenous
fertilizers with proforma 'B')
| 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.3 of the Proforma B (MT) |
Rate of
Concession (Rs./MT)
|
Amount
of Concession (Rs.)
|
Remarks
|
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| 1 |
IMPORTED DAP |
|
|
|
|
| 2 |
MOP |
|
|
|
|
| 3 |
INDIGENOUS
DAP |
|
|
|
|
| 4 |
COMPLEXES |
|
|
|
|
| 5 |
SSP |
|
|
|
|
| |
Total |
|
|
|
|
| |
Less:
"On Account" payment already received
vide Bill No._________________ dated______ |
|
|
| |
Amount
now receivable |
|
|
Total amount claimed being rounded
off Rs._________ (Rupees______________________________________)
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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