CHALLAN CHALLAN CHALLAN

Unique Reference No. 193702216532 Unique Reference No. 193702216532 Unique Reference No. 193702216532
Date : _____________________ Date : _____________________ Date : _____________________
Internal Fund Transfer [ ] NEFT/RTGS [ ] Internal Fund Transfer [ ] NEFT/RTGS [ ] Internal Fund Transfer [ ] NEFT/RTGS [ ]

Bank : INDIAN BANK, IFSC Code :IDIB000P027 Bank : INDIAN BANK, IFSC Code :IDIB000P027 Bank : INDIAN BANK, IFSC Code :IDIB000P027
Account No. Account No. Account No.

6 6 8 8 7 2 7 7 5 6 6 6 8 8 7 2 7 7 5 6 6 6 8 8 7 2 7 7 5 6
Account Holder Name : BSFC - EPDS Code 200000056183. Account Holder Name : BSFC - EPDS Code 200000056183. Account Holder Name : BSFC - EPDS Code 200000056183.
Paid in the credit of Paid in the credit of Paid in the credit of
Cheque No & Name of Bank Rs. Ps. Cheque No & Name of Bank Rs. Ps. Cheque No & Name of Bank Rs. Ps.

TOTAL TOTAL TOTAL

Amount (inwords) Rs. Amount (inwords) Rs. Amount (inwords) Rs.

UTR No. : UTR No. : UTR No. :

Transction ID : Transction ID : Transction ID :

Receiving Officer Stamp Receiving Officer Stamp Receiving Officer Stamp

PDS DEALER PDS DEALER PDS DEALER

EPDS Code : 200000056183 EPDS Code : 200000056183 EPDS Code : 200000056183
Name : Poonam Kumari Name : Poonam Kumari Name : Poonam Kumari
Locality : CHARNE Locality : CHARNE Locality : CHARNE
Panchayat : Charna Panchayat : Charna Panchayat : Charna
Block : Chhatapur District : Supaul Block : Chhatapur District : Supaul Block : Chhatapur District : Supaul
Allocation No. : 584 Date of Allocation : 30-10-2019 Allocation No. : 584 Date of Allocation : 30-10-2019 Allocation No. : 584 Date of Allocation : 30-10-2019
Payment for the month of December-2019 Payment for the month of December-2019 Payment for the month of December-2019
Quantity Quantity Quantity
Scheme Amount (Rs.) Scheme Amount (Rs.) Scheme Amount (Rs.)
(Quintals) (Quintals) (Quintals)
PHH Wheat 29.72 3,863.60 PHH Wheat 29.72 3,863.60 PHH Wheat 29.72 3,863.60
PHH Rice 44.58 10,253.40 PHH Rice 44.58 10,253.40 PHH Rice 44.58 10,253.40
Total 74.30 14,117.00 Total 74.30 14,117.00 Total 74.30 14,117.00
Advance Amount 0 Advance Amount 0 Advance Amount 0
Amount to be Paid 14,117.00 Amount to be Paid 14,117.00 Amount to be Paid 14,117.00

Sigature of Dealer Sigature of Dealer Sigature of Dealer

BANK COPY Generated On 14 Nov 2019 08:43:14 BSFC COPY Generated On 14 Nov 2019 08:43:14 DEALER COPY Generated On 14 Nov 2019 08:43:14