(Form PTR 16, Rule 107 of PTR Volume)

(For use of Treasury only)

 Serial No.: __________


(To be filled in by the tenderer)  
By Whom Tendered : ______________________________________________________________
Purpose of  Deposit : ______________________________________________________________
Amount (in figures) Rs. _______ (in words) Rs. ____________________________
Treasury / Sub Treasury Code






( Name of the Treasury/ Sub Treasury)

DDO Code





(Designation of the DDO)
(whose behalf Money deposited)
Plan/ Non Plan/CSS
  (P for Plan, N for Non-Plan , S for CSS)
Major Head Sub-Major Head Minor Head Sub Head
(Complete Head of Account)



(Signature of Tenderer)


(For use of Department of Treasury Only)

 Order to the Bank 


Receipts and Gross Receipt

 Department Officer or DTO/ TO  (With Seal)


 Received Rs. _______________ (in words) ___________________________________

 Authorised Signatory of the Bank

 (Details of the Money Deposited)


Drawee Bank Branch Cheque/ Draft No. Dated Cash Details Rupees Paise
1.         Rs.  1000 X      
2.         Rs. 500 X      
3.         Rs. 100 X      
4.         Rs. 50 X      
5.         Rs. 20 X      
6.         Rs. 10 X      
7.         Rs. 5 X      
8.         Rs. 2 X      
9.         Rs. 1 X      
10.         Coins      


1. A Separate Challan may be used for every complete Head of Account.

2.  Incomplete / Incorrect Challan or Challan not verified by the Department are liable to be rejected by the Bank.