Branch Name & Code :  To     Mr./ Mrs. :

Advice No. Advice Date Payment Date

A/C Head (Dr. Particulars)	GL Code	Amount Rs.	A/C Head (Cr. Particulars)	GL Code	Amount Rs.

Cash Deposit in   From ( ) (In Words : Through )

Full Signature  __________________________ Name & Code  __________________________ Cashier Full Signature  __________________________ Name & Code  __________________________ Authorize Person

please paste image ? Signature of Member/Receiver