Appendix 21 A

Format for Deposit of Application Fee

Bank Receipt Number and Date

Receipt of Cash paid into the Central Bank of India at ..............................

To be Filled in by the Remitter						To be filled in by the department officer of the bank
By whom tendered	Name, designation and address of the person on whose behalf money is paid	Full particulars of the remittance and of authority (if any)	Amount		Head of account	Accounts officer by whom adjustable	Order to be Bank*
			Rs.	P.
Name Signature					1453 foreign trade export promotion – minor head – 102 import licence application fee	Pay and Accounts officer .......... (Name of station)	Date, correct receipt and grant receipt (signature and full description of the officer ordering the money to be paid in)
* (in words) Rupees						* To be used only in the case of remittance to the Bank through Departmental Officer

Cashier

Accountant

Date

Bank officer

Note:-

1. Particulars of money tendered should be given below.

2. In case where direct credits at Bank are permissible the Column "Head of Account" will be filled in by the Bank Officer or Pay and Accounts Officer as the case may be, on the receipt of Bank's daily statement

Particulars	Amount
Coins Notes (with details) Cheque (with details) Total Rs.	Rs.	P.