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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.
  1. Monthly commission paid certificate from the Post Master concerned.
  2. Receipt in the proforma enclosed
  3. Certificate of Authority Xerox copy

For MPKBY Agents
  1. Check slip prepared by the Agent along with ASLAAS 6 Form duly signed by the Post Master with date stamp.
  2. Receipt in the proforma enclosed
  3. 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.
  1. Incentive Amount:
   
  1. By credit to POSB:
   
  1. 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