Ex-Servicemen Contributory Health Scheme (Echs) Application Form For Membership (Rev 2015) Page 14

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6
in lieu of IAFF (A) 507
MILITARY RECEIVABLE ORDER
Bank’s Counterfoil (To be forwarded to the CDA)
(To be filled in by MRO issuing authority)
Received a sum of Rs
Total (Rs in words)
---- hundreds
------ Tens
------ units
----- Crores
------ lakhs
--- thousands
From ………………………………..………………………………. (name of the individual/unit/office)
By Cash/Cheque No ………… Date ……….. Bank ……… for credit to PCDA/CDA ………………..
……………………………………… on account of ………………………………. as Defence receipts
(Signature of the Issuing Officer)
Unit/Officer
BSR Code
D D M M Y Y
Serial No
Bank Seal
---------------------------------------------------------------------------------------------------------------------------------------------------------------
Depositor’s Counterfoil-1 (To be retained by the Depositor)
(To be filled up by Treasury/RBI/Bank)
Treasury/RBI/Bank …………………
Dated …..…………
Received a sum of Rs ……………….……………..(Rupees ……………….…………………. Only)from ……………….
(individual/Unit/Officer) on account of …………………….. for credit toPCDA/CDA……………… as Defence Receipt
BSR Code
D D M M Y Y
Serial No
Bank Seal
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Depositor’s Counterfoil-2 (To be forwarded to PCDA/CDA)
(To be filled up by Treasury/RBI/Bank)
Dated ..………
Treasury/RBI/Bank …………………
Received a sum of Rs ……………….…………….. (Rupees ……………….…………………. Only) from………….….
(individual/Unit/Officer) on account of …………………….. for credit to PCDA/CDA ………………………… as Defence
Receipt
BSR Code
D D M M Y Y
Serial No
Bank Seal
----------------------------------------------------------------------------------------------------------------------------------------------------------------
Depositor’s Counterfoil-3 (To be retained by Stn HQ/Regional Centre)
(To be filled up by Treasury/RBI/Bank)
Dated ..………
Treasury/RBI/Bank …………………
Received a sum of Rs ……………….…………….. (Rupees ……………….…………………. Only) from………….…..
(individual/Unit/Officer) on account of …………………….. for credit to PCDA/CDA ………………………… as Defence
Receipt
BSR Code
D D M M Y Y
Serial No
Bank Seal

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