| FORM 'E' |
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FORM 'E' |
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FORM 'E' |
| Permit for issue of fertilisers |
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Permit for issue of fertilisers |
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Permit for issue of fertilisers |
| [SeeRule 15] |
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[SeeRule 15] |
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[SeeRule 15] |
| ORIGINAL |
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ORIGINAL |
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ORIGINAL |
| No.................. date ........ |
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No.................. date ........ |
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No.................. date ........ |
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Shri.................. of.................... the bearer ofthis permit, having been granted
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Shri.................. of.................... the bearer ofthis permit, having been granted
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Shri.................. of.................... the bearer ofthis permit, having been granted
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a loan of Rs........... (in figures as well asin words) under the Orissa Fertilisers Loans Rules, 1965, isallowed hereby to obtain from ..............(name of thecooperative society) chemical fertilisers of his choice to theextent of the aforesaid amount.
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a loan of Rs........... (in figures as well asin words) under the Orissa Fertilisers Loans Rules, 1965, isallowed hereby to obtain from ..............(name of thecooperative society) chemical fertilisers of his choice to theextent of the aforesaid amount.
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a loan of Rs........... (in figures as well asin words) under the Orissa Fertilisers Loans Rules, 1965, isallowed hereby to obtain from ..............(name of thecooperative society) chemical fertilisers of his choice to theextent of the aforesaid amount.
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2. This permit is valid till the......... dayof...... 20..... and shall not be honoured thereafter unlessrevalidated by the competent authority in the space indicatedtherefor.
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2. This permit is valid till the......... dayof...... 20..... and shall not be honoured thereafter unlessrevalidated by the competent authority in the space indicatedtherefor.
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2. This permit is valid till the......... dayof...... 20..... and shall not be honoured thereafter unlessrevalidated by the competent authority in the space indicatedtherefor.
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| (Signature of the officer sanctioning the loan) |
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(Signature of the officer sanctioning the loan) |
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(Signature of the officer sanctioning the loan) |
| (Seal)(Designation) |
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(Seal)(Designation) |
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(Seal)(Designation) |
| Date................... |
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Date................... |
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Date................... |
| Space for revalidation |
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Space for revalidation |
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Space for revalidation |
| Revalidated till the....... |
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Revalidated till the....... |
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Revalidated till the....... |
| Day of............. 20........... |
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Day of............. 20........... |
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Day of............. 20........... |
| Date................ |
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Date................ |
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Date................ |
| (Signature of Tahsildar or Officer sanctioning the Loan) |
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(Signature of Tahsildar or Officer sanctioning the Loan) |
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(Signature of Tahsildar or Officer sanctioning the Loan) |
| (Designation) |
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(Designation) |
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(Designation) |
| Received the duplicate of the permit |
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Received the duplicate of the permit |
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Received the duplicate of the permit |
| (Signature of the loanee) |
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(Signature of the loanee) |
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(Signature of the loanee) |
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1. *No. and date of despatch to the co-operativesociety..............
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1. *No. and date of despatch to the co-operativesociety..............
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1. *No. and date of despatch to the co-operativesociety..............
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| 2. *Date of receipt by the co-operative Society............. |
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2. *Date of receipt by the co-operative Society............. |
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2. *Date of receipt by the co-operative Society............. |
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3. *Date of presentation of the duplicate by theloanee..........
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3. *Date of presentation of the duplicate by theloanee..........
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3. *Date of presentation of the duplicate by theloanee..........
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| 4. *Type, quantity and cost of fertilisers issued- |
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4. *Type, quantity and cost of fertilisers issued- |
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4. *Type, quantity and cost of fertilisers issued- |
| Type | Quantity | Rate | Cost |
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Type | Quantity | Rate | Cost |
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Type | Quantity | Rate | Cost |
| Total............... |
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Total............... |
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Total............... |
| 5. *Date of delivery of fertilisers |
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5. *Date of delivery of fertilisers |
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5. *Date of delivery of fertilisers |
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6. *Signature of the Secretary, employee or office-bearer ofCooperative Society..........
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6. *Signature of the Secretary, employee or office-bearer ofCooperative Society..........
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6. *Signature of the Secretary, employee or office-bearer ofCooperative Society..........
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| 7. I**Received fertilisers as described in the above statement |
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7. I**Received fertilisers as described in the above statement |
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7. I**Received fertilisers as described in the above statement |
| Witnesses : |
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Witnesses : |
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Witnesses : |
| (1) |
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(1) |
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(1) |
| (2) |
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(2) |
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(2) |
| (Signature of the loanee) |
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(Signature of the loanee) |
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(Signature of the loanee) |
| Date........... |
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Date........... |
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Date........... |
| 8. *Date of return to Tahsildar for non-presentation |
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8. *Date of return to Tahsildar for non-presentation |
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8. *Date of return to Tahsildar for non-presentation |
| [SeeRule 16(3)] |
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[SeeRule 16(3)] |
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[SeeRule 16(3)] |
| 9. *Date of return to Tahsildar for reimbursement of cost. |
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9. *Date of return to Tahsildar for reimbursement of cost. |
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9. *Date of return to Tahsildar for reimbursement of cost. |
| 10. *Date of reimbursement |
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10. *Date of reimbursement |
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10. *Date of reimbursement |
| 11. *Any other particulars- |
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11. *Any other particulars- |
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11. *Any other particulars- |
| To be filled in by Tahsildar or sanctioning authority |
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To be filled in by Tahsildar or sanctioning authority |
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To be filled in by Tahsildar or sanctioning authority |
| To be filled in by the loanee. |
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To be filled in by the loanee. |
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To be filled in by the loanee. |
| To be filled in by Co-operative Society. |
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To be filled in by Co-operative Society. |
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To be filled in by Co-operative Society. |
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N.B.: In the duplicate items 3 to 7 need only befilled up.
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N.B.: In the duplicate items 3 to 7 need only befilled up.
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N.B.: In the duplicate items 3 to 7 need only befilled up.
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