121Schedule – 20
(Related to Sub-rule (5) of Rule 36a.)
Receipt of the recovery of loan given by the Village/Town Committee
…………………Village Committee / Town Committee
……………….. District
Out of the loan given by Mr. ………………………. resident of ………………….
Village Development Committee / Municipality Ward No. …………………,
principal in kind ……………………………… (name & quantity) which is equivalent
to cash Rs. …………………….. and interest of ………. days up to this date
………………………… (name & quantity) in kind, equivalent to Rs. ……………………
altogether …………………….. (name & quantity) in kind equivalent to Rs.
…………………. (in words) …………………. has been received.
Seal Signature of the person received by ………….
……………………. Date :- ……………………
Note :- Instead of “Gazette”, “Office” & “Appeal”, “Rajpatra”, “Karyalay”
and “Punarabedan” has been inserted accordingly by making the
alteration.

121 Inserted by Fifth Amendment.