Subscriber's Copy Agent's Copy [See sub paragraph (3) of paragraph 4]
Public Provident Fund Scheme, 1968

Name of Agent
……………………
Name of Agent ………….. Paper
Toke No………
Name of Accounts Office Code No…………………. Code No…………………………
Account No…………. Date
…………
Public Provident Fund Scheme,
1968
PUBLIC PROVIDENT FUND
SCHEME, 1968
Ledger Folio ……………. Name of Accounts Office
Challan for deposit of money into
Government Account ……………..
(name of Accounts Office)
Name of Subscriber
………………….
Account No…………. Date
…………
Account No…………….. Date
……………..
Amount Deposited Cash/Cheque
(Rs.) Ledger Folio ……………. Name of Subscriber ………….
Ledger Folio ……
Subscription
…………………………
Name of Subscriber
………………….
Address
………………………………………
Loan repayment
……………………..
Amount Deposited Cash/Cheque
(Rs.)
Cas
h
Amou
nt
Amount
(in
figures)
Head of
Govt
Accoun
t
Interest on loan
…………………………
Subscription
…………………………
100
x
50
x
Subscripti
on
Loan
8006 -
Public
Provide
nt Fund'
Fee
…………………………………
…
Loan repayment
……………………..
20
x
10
x
Repaymen
t
Total
…………………………………
Interest on loan
………………………… 5 x
Fee
…………………………………
…
*
Cheque/draft/
Postal Order
Interest on
loan Fee
2049 -
Interest
Receipt
s' Other
Receipt
s
Total
………………………………… Total
Rupees (in words)
………………………
…………………………………
……….
Rupees (in words)
………………………
…………………………………
……….
* Bank/PO on which drawn
……………. Number ……………
Rupees (in words)
By (Depositor's Signature)