FORM JK/ED-I0 [See rule 17(4)] Voucher No............... Refund Statement Approved for payment of Rupees ... ... ... ... ... ... ... ...(both in words and figures) and certified that the stamps described below, refund of value of which has been allowed, subject to the prescribed deduction have been destroyed. Place ... ... ... ... ... ... ... Dated... ... ... ... ... ... ... Commissioner. Name of applicant Description Of Stamps Value of Stamps (both in Words and Figures) Amount of Deduction Date of Application for Refund Authority for Refund Received payment Six naye paise receipt stamps if required For sums over Rs.20.00 Pay Rupees .........(both in words and figures) District ......... Dated .......... Head Treasury Clerk. Treasury Officer
