Form No. GFR- 19A Name of the District :- ________________________________ UTILIZATION CERTIFICATE FOR THE YEAR __________ Dated:_________ Sanction letter no. and date Purpose Amount Certified that out of Rs.______ /- (Rupees _______________________ only) of Grants-in-aid sanctioned during the financial year 20___ - 20___ in favour of the ________________ by the ________________ as per letter R. No. ________________ and Rs. ______ /- (Rupees _______________________ only) on account of unspent balance of the previous years (20___ - 20___), a Sum of Rs. ________ /- (Rupees _______________________ only) has been utilised for the purpose for which it was sanctioned and that the balance of Rs.________ /- (Rupees _______________________ only) Remained as unutilised at the end of the year, will be adjusted towards the grants-inaid payable during the next year. Further certified that I have satisfied myself that the conditions, on which the grantsin-aid was sanctioned, have been duly fulfilled and that I have exercise the following checks to see that the money was actually utilised for the purpose for which it was sanctioned. Checks exercised: Examing of a) Cash book/Bank Pass book b) Monthly & Quarterly statements of expenditure c) Ledgers Signature. Note: i) ii) Unspent balance /Unutilized amount of previous year plus released of funds during the year under audit are the “total funds available”. Closing balance of the year means “amount remained un-utilised or not spent,” Model Format Name of the Office : Statement of Expenditure Incurred (SOE) 20___ - ___ Sl. No. Opening Balance as on 01.04.___ Component Fund Received from SHS 20___ - ___ Expenditure Incurred April May June July Aug. Sep. Oct. Nov. Dec. Jan. Feb. Mar. Total Expens es Closing Balance as on 31.03.____ Total 10 Bank Interest Balance as per Day Book Signature.