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 ______ 2013 of Finance (Pension.I) Department]

 d to the CSS Account in respect of Sri / Smt. / Kum.
ation: _____________________, Emp. Id. No. __________________,
 _________________________.

_________________

tion Id. Amount transferred  Amount paid in
h Date             to CPS            cash
   1   2   3   4   5   6   7   8   9   10