Department

Salary page No.

RECEIPT

Received from the Registrar, Indian Institute of Technology, Powai, Bombay- 76 the sum of Rs.

( Rupees ) being my for the month of



Signature attested by me

Signature
Head of Dept./Section

AUTHORITY

I hereby authorise Shri./Smt to receive the sum of Rs.

(Rupees ) being my for the month of 20


Signature

LIFE CERTIFICATE

Certified that Shri./Smt. is alive to day date 20 .




Signature