| Sl.No. |
Date of Applica-
tion |
Name of Applicant |
Petition No. |
Particulars of the document
whose copy is received |
Amount Rece-
ived |
Particulars of Demand
Draft/Pay Order No. Date
Bank |
No. Of Pages |
Addl. Amount and particulars of
Demand Draft /Pay Order |
Date of prepara-
tion |
Date of Delivery |
Signature of person receiving |
Remarks |