GOVERNMENT OF KERALA GOVERNMEN

CHALAN ORIGINAL CHA

FORM T.R. 12 FORM

(See Rules 102 ( c ) & 124 of Kerala Treasury Code) (See Rules 102 ( c ) & 124

Chalan for Payment of Money into the Chalan for Payment

District Treasury / Sub Treasury District Treasury
State Bank of India / State Bank of Travancore State Bank of India / Sta
At At
Computer Seq No. Date Computer Seq No.

Head of Account Head of Account

Maj Smj Min Sub: Subsub

*DDO Code (Dept) (DDO) *DDO Code

*SDO Code *SDO Code

By whom paid & Name & Purpose of By whom paid & Name &
address of the person on remittance & Amount in Order to address of the person on
RS the Bank
whose behalf money is paid authority , if any whose behalf money is paid

Correct
Receive and
grant
receipt

Treasury
Total Officer

Total in words: Total in words:

Signature of Remitter : Signature of Remitter :
Received Rs. Seal Received Rs.
(Rupees (Rupees
Date : Date :
Signature of Treasurer/ Cashier/ Treasury Officer/ Bank Ma Signature of Treasurer/ Cas
Note : Note :
1. The Seal/stamp of the Treasury/ Bank collection shall be afixed. 1. The Seal/stamp of the Treasury/ Bank co

2. If remittance is in official capacity (*SDO/DDO),write corresponding 2. If remittance is in official capacity (*SDO

code in the column provided. code in the column provided.

3. if loan repayment of SDO,write installment number in purpose column. 3. if loan repayment of SDO,write installme
 GOVERNMENT OF KERALA GOVERNMENT OF KERALA
CHALAN DUPLICATE CHALAN
FORM T.R. 12 FORM T.R. 12

(See Rules 102 ( c ) & 124 of Kerala Treasury Code) (See Rules 102 ( c ) & 124 of Kerala Treasury Code)

Chalan for Payment of Money into the Chalan for Payment of Money into the
District Treasury / Sub Treasury District Treasury / Sub Treasury
State Bank of India / State Bank of Travancore State Bank of India / State Bank of Travancore
At
Date Computer Seq No. Date

Head of Account
Maj Smj Min Sub: Subsub Maj Smj

(Dept) (DDO) *DDO Code (Dept)

*SDO Code

whom paid & Name & Purpose of By whom paid & Name & Purpose of
dress of the person on remittance & Amount in Order to address of the person on remittance &
RS the Bank
se behalf money is paid authority , if any whose behalf money is paid authority , if any

Correct
Receive and
grant
receipt

Treasury
Total Officer Total
Total in words:
ature of Remitter : Signature of Remitter :
Seal Received Rs.
(Rupees
Date :
ature of Treasurer/ Cashier/ Treasury Officer/ Bank Ma Signature of Treasurer/ Cashier/ Treasury Officer/
Note :
Seal/stamp of the Treasury/ Bank collection shall be afixed. 1. The Seal/stamp of the Treasury/ Bank collection shall be afixed.

mittance is in official capacity (*SDO/DDO),write corresponding 2. If remittance is in official capacity (*SDO/DDO),write corresponding

the column provided. code in the column provided.

n repayment of SDO,write installment number in purpose column. 3. if loan repayment of SDO,write installment number in purpose column.
NT OF KERALA
TRIPLICATE

T.R. 12

of Kerala Treasury Code)

of Money into the

y / Sub Treasury
ate Bank of Travancore

Min Sub: Subsub

(DDO)

Amount in Order to
RS the Bank

Correct
Receive and
grant
receipt

Treasury
Officer

Seal

hier/ Treasury Officer/ Bank Manager.

llection shall be afixed.

/DDO),write corresponding

nt number in purpose column.