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State of Assam - Section
Section 84 in The Bengal Public Demands Recovery Act, 1913
84. Forms in Appendix. - The Forms set forth in the Appendix shall be used, with such variations as circumstances may require.
Form No. 1[See Sections 4 and 6][To be filed in the office of the Certificate Officer of..........(name of district)]| No. of certificate | Name and address of certificate holder | Name and address of certificate debtor | Amount of public demand [including interest ifany, and including the fee paid under Section 5, sub-section (2)if any] for which this certificate is signed and period for whichsuch demand is due | Further particulars of the public demand forwhich this certificate is signed. |
| 1 | 2 | 3 | 4 | 5 |
| Name of certificate debtor | Address of certificate debtor | Amount of public demand for which thisrequisition is made | Name of the public demand and for which therequisition is made |
| 1 | 2 | 3 | 4 |