Form 12 — GFR

FORM 12 [(See Rule 238 (1)] UTILIZATION CERTIFICATE FOR THE YEAR………….. in respect Grant received during the year Total Available Expenditure Closing Balances incurred funds (1+2-3+4) (5-6) 1 2 3 4 5 6 7 Date Amount

(ii)

(iii) Total assets

Certified that I have satisfied myself that the conditions on which grants were sanctioned have been duly fulfilled/are being fulfilled and that I have exercised following checks to see that the money has been actually utilized for the purpose for which it was sanctioned:

(i) The main accounts and other subsidiary accounts and registers (including assets registers) are maintained as prescribed in the relevant Act/Rules/Standing instructions (mention the Act/Rules) and have been duly audited by designated auditors. The figures depicted above tally with the audited figures mentioned in financial statements/accounts.

(ii) There exist internal controls for safeguarding public funds/assets, watching outcomes and achievements of physical targets against the financial inputs, ensuring quality in asset creation etc. & the periodic evaluation of internal controls is exercised to ensure their effectiveness.

(iii) To the best of our knowledge and belief, no transactions have been entered that are in violation of relevant Act/Rules/standing instructions and scheme guidelines.

(iv) The responsibilities among the key functionaries for execution of the scheme have been assigned in clear terms and are not general in nature.

(v) The benefits were extended to the intended beneficiaries and only such areas/districts were covered where the scheme was intended to operate.

(vi) The expenditure on various components of the scheme was in the proportions authorized as per the scheme guidelines and terms and conditions of the grants-in-aid.

(vii) It has been ensured that the physical and financial performance under…………….(name of the scheme has been according to the requirements, as prescribed in the guidelines issued by Govt. of India and the performance/targets achieved statement for the year to which the utilization of the fund resulted in outcomes given at Annexure - I duly enclosed.

(viii) The utilization of the fund resulted in outcomes given at Annexure - II duly enclosed (to be formulated by the Ministry/Department concerned as per their requirements/specifications.)

(ix) Details of various schemes executed by the agency through grants-in-aid received from the same Ministry or from other Ministries is enclosed at Annexure - II (to be formulated by the Ministry/Department concerned as per their requirements/specifications). Date: Place: Signature: Signature: Name.......................................................... Name....................................................... Chief Finance Officer Head of the Organisation (Head of the Finance) (Strike out inapplicable terms)

FORM 12 [See Rule 256 (2)]

FORM OF UTILIZATION CERTIFICATE (1) Certified that out of the Loan of Rs. …….........…....……. SANCTIONED under…………………………………... dated…………………….…..,in favour of ………….....………….during the year……………………......an amount of Rs…………………………...has been utilized for the purpose for which it was sanctioned, and that the balance of Rs. ………...................remaining unutilized at the end of the year…………………….has been surrendered to the Government (vide No. ……….………., dated…………………..) / will be adjusted towards the loan payable during the next financial year. (2) Certified that I have satisfied myself that the conditions on which the loan was sanctioned have been duly fulfilled/are being fulfilled and that I have exercised the following checks to see that the money was actually spent for the purpose for which the loan was made. Kinds of checks exercised 1. 2. 3. 4. Signature…….….……………………. Designation …………………………. Date …………………………………..

(Where expenditure incurred by Govt. bodies only) Sl. No. Letter No. and date

FORM 12 [(See Rule 239)]

FORM OF UTILIZATION CERTIFICATE (FOR STATE GOVERNMENTS) Amount Certified that out of Rs……………………………………………...........Of grantssanctionedduringtheyear.................................infavourof ..........................................................undertheMinistry/Department Letter No. given in the margin and Rs…………………………..on Account of unspent balance of the previous year, a sum of Rs…………………………….has been utilized for the propose of ............................................for which it was sanctioned and that The balance of Rs…………………………..remaining unutilized At the end of the year has been surrendered to Government (vide No. Total ...........................dated.......................)/will be adjusted towards the grants payable during the next year........................................ 2. Certified that I have satisfied myself that the conditions on which the grants-in-aid was sanctioned have been duly fulfilled/ are being fulfilled and that I have exercised the following checks to see that the money was actually utilized for the propose for which it was sanctioned. Kinds of checks exercised 1. 2. 3. 4. 5. Signature……………………………………… Designation…..……………………………….. Date…………………………………………… PS: The UC shall disclose separately the actual expenditure incurred and loans and advances given to suppliers of stores and assets, to construction agencies and like in accordance with scheme guidelines and in furtherance to the scheme objectives, which do not constitute expenditure at the stage. These shall be treated as utilized grants but allowed to be carried forward.

SI. No. Sub-Major Name of the Aggregate outstanding Head Minor Head borrower of Account balance of loan(s)