SMALL SAVINGS AGENTS INCENTIVE APPLICATION FORM


GOVERNMENT OF TAMIL NADU SMALL SAVINGS AGENTS INCENTIVE APPLICATION FORM
				Application Number:....................
District Code: ....................		Block Code: ....................		Agent Code:....................
Year ....................				CA Number ..................
Month....................				Agency SAS /MPKBY / PPF
Agent's Name.................... ....................				Validity From ............... to..................
Address ........................................				POSB A/c. No.:....................
.................... .................... ....................				Name of the Account Holding HPO
Attached Post Office				..................................................................
Details of Commission Received: SAS / PPF/MPKBYAgents:
Sl.No.	Schemes	Amount of Commission paid by P.O. for the month	Sl.No.	Schemes	Amount of Commission paid by the RDNS for the period ...........
1	KVP		1	PPF
2	MIS		2	DSRGE/ DSRPSE
3	TD
4	NSC
5	NSS'92
6	RD

Total Commission received from Post Office				Rs.
Total Commission received from RDNS				Rs.
Grand Total				Rs.
Incentive being claimed now:
a) SAS (100% of the Commission amount earned from Post Office)				Rs.
b) MPKBY (50% of the commission amount from Post Office)				Rs.
c) PPF/DSRGE (100% of the Commission amount earned NSO)
Total incentive being claimed for the month of ...........................				Rs.
ACKNOWLEDGEMENT
				Application No. ............................
District Code ......		Block Code .......		Agent Name & Code ..................
Signature of the E.O.		(SS)/FO ......................................

DECLARATION BY THE AGENT
I hereby declare that the above particulars furnished by me and deposits are motivated by me Certified that I have not prefrerred the claim previously for the month. Certified that excess amount if any paid to me will be refunded on intimation. I also certify that I have given investment details only to my appointing authority and not to any other officials in the District, and if any complaints on this matter, I agree to take any action against me by the District Collector or the appointing authority.
Agent Signature
Enclosures:
For SAS Agents.
Monthly commission paid certificate from the Post Master concerned. Receipt in the proforma enclosed Certificate of Authority Xerox copy
For MPKBY Agents
Check slip prepared by the Agent along with ASLAAS 6 Form duly signed by the Post Master with date stamp. Receipt in the proforma enclosed Certificate of Authority Xerox copy
Note: Separate application forms are to be used for SAS/MPKBY/PPF agencies.
ADVANCE RECEIPT
Received a sum of Rs. ................................ (Rupeess ................................................................................. only) from the Collector, ....................... District towards State Incentive for the period from ................. to .....................
District Code:................	Block Code...................	Agent Code ...................
Signature of the Agent

ABSTRACT SHOWING THE AGENTS INCENTIVE CLAIM FORMS HANDEDOVER TO THE P.A. (SS & R) OF THE DISTRICT BY THE DISTRICT BY THE E.O. (SS)/ FIELD OFFICERS. (This form should be given to the P.A. (SS & R) in Duplicate)
Block Code ..........................			Year ..................................................
Application Number	Agency Name MPKBY/ SAS/PPF	Agent Code No.	Agent name	Month(s) for which the claime made	Amount of incentive claim




















Signture of the E.O.(SS&R) with date
ACKNOWLEDGEMENT
Received the applications as above
Signture of the E.O.(SS&R) with date

RECEIPT
Received a sum of Rs. .................................. (Rupees .............................................................................................. only) from the Collector, ............................... District in respect of SAS/MPKBF/PPF agency, towards the State Incentive for the month of ......................................
District Code .......................	Block Code ................	Agent Code ......................

		Signature of the Agent
		C.A. No.:
		Valid upto: ..........................

For Office Use
Agent's Ledger Folio Number	..................................
MPKBY
Month	Total Amount of Investment	50% of Commission



SAS / PPF AGENTS
Period of Investment	Total amount of commission paid by	Incentive (100% of the commission amount, amount earned from Post Office / RDNS)
	Post Office: Rs.	Post Office: Rs.
	RDNS : Rs.	RDNS : Rs.
	Total : Rs.	Total : Rs.
Incentive Amount:
By credit to POSB:
By TDS at 2%:
	_{___________________________________}
Total
Passed for Rs. ............................... (Rupees ...................................................................................................... .................................................................)
A.D. & P.A. (SS & R) to Collector.

COMMISSION PAID CERTIFICATE
Monthly schedule of Deposit made by ................................. .....................................
SAS Agent CA No. ..................................................................................................
Post Office for the month of .....................................................................................

Sl. No.	Scheme in which deposit made	Amount paid	PB No./Cert No. with date of issue	Amount of Commission paid	Remarks





_________________________________________________________________________________________
Total Commission Received.

................................................
Signature of the Agent with Date CA. No.
CERTIFICATE BY POST OFFICE
This is to certify that Thiru / Tmt ............................................................................ SAS Agent CA No. ............... ................................ .............. is paid commission of Rs. ...................... (Rupees ............ ............................................. ................ ) during the month of ......................... @ Post Office under ............ HPO ...................
Date Stamp
Signature of Post Master