TO BE PAID THROUGH SYSTEM ONLY

PFMS Generated Print Payment Advice

Approval date in PFMS: 29 Oct 2024 Payment Advice No.: C102454185898
Expiry date of PPA PFMS: 08 Nov 2024 Advice Print Date : 29 Oct 2024
PAN No. : TAN No.: NGPT02334D
Note For Branch: Kindly process the payment advice through CPSMS application by login through i-View(i-
Sense) application and share 16 digit Acknowledgement (PI number) with the client.
Contact Details BANK PFMS
Name: ICICI Bank PFMS Team
Email : [email protected] [email protected]
Phone No. : 040 - 33593555 011-23343860
Note:
To, For Agency: Kindly submit this advice duly signed to the branch at the earliest, post approval in PFMS
system, to avoid any delay in payments.
The Branch Head
ICICI BANK LTD
SANGLI-SHIVAJINAGAR(N) Branch

We authorise the bank to debit our undernoted account maintained with the bank with batch
amount and credit the beneficiary(ies) [#127] as per ANNEXURE-I uploaded to bank's central
system through PFMS O/o CGA.
Bank Account No. 107201005481 Total Amount of Debit : Rs 4,71,960.00
(Amount in words : Four Lakhs Seventy-One Thousand Nine
Hundred Sixty )
No. Of Beneficiaries as per Annexure-I. Batch No. C102454185898

Agency Seal
.................................................. ..................................................
(Sign by Authorized Signatory) (Sign by Authorized Signatory)
Name - ________________________ Name - ________________________
Designation - __________________ Designation - __________________
Mobile No - ____________________ Mobile No - ____________________

To,
TALUKA HEALTH OFFICE AMGAON NHM FUNDS-[MHGO00001036]
Ref: Account No. 107201005481 / Payment Advice Number C102454185898
We confirm having received the captioned advice of credit(s) for payment today for further
processing as per arrangement of bank on integrated PFMS-Bank payment system.
No. Of Beneficiaries : 127 Amount (in Rs.) : 4,71,960.00
Date & Time :

ICICI BANK LTD Branch Seal Branch Authorized Official

Agency to enter date of delivery in PFMS using option | E-Payment => PPA Submission Status

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
1 ALKA AJAY C102454185957 <Aadhaar Based> xxxxxxx0984 2,940.00
CHANNE
2 ANJU PRITAM C102454185910 <Aadhaar Based> xxxxxxx1985 2,945.00
RAHANGADALE
3 ANUSAYA C102454185891 <Aadhaar Based> xxxxxxx7406 3,835.00
SHYAMLAL
PATLE
4 ANWANTA C102454185958 <Aadhaar Based> xxxxxxx0497 4,340.00
RAJKUMAR
GEDAM
5 ARCHANA C102454185959 <Aadhaar Based> xxxxxxx9692 2,570.00
BALARAM UIKEY
6 ASHA HANSRAJ C102454185960 <Aadhaar Based> xxxxxxx2082 3,530.00
MESHRAM
7 ASHA KAMAL C102454186014 <Aadhaar Based> xxxxxxx6937 4,245.00
MESHRAM
8 ASHABAI C102454185911 <Aadhaar Based> xxxxxxx8024 3,235.00
MADHUKAR
SHIVANKAR
9 BABITA ARVIND C102454185912 <Aadhaar Based> xxxxxxx9444 3,650.00
MESHRAM
10 BAYANBAI C102454185913 <Aadhaar Based> xxxxxxx6424 3,460.00
CHANDRABHOJ
SAYAM
11 BHARTI ANAND C102454185914 <Aadhaar Based> xxxxxxx3704 4,020.00
SHENDE
12 BHARTI HEMRAJ C102454185915 <Aadhaar Based> xxxxxxx6343 4,195.00
KADBANDHE
13 BHOJWANTA C102454185916 <Aadhaar Based> xxxxxxx7181 3,495.00
RAJKUMAR
KUMBHRE
14 CHANDA C102454185961 <Aadhaar Based> xxxxxxx2005 4,150.00
MANMOHAN
BISEN
15 DAMYANTI C102454185962 <Aadhaar Based> xxxxxxx4492 2,775.00
MAHESH KATRE
16 DEVANGANA C102454185917 <Aadhaar Based> xxxxxxx4947 4,210.00
PUNDLIK
KARANJEKAR
17 DHANESHWARI C102454185918 <Aadhaar Based> xxxxxxx0602 3,060.00
TEKACHAND
RAHANGDALE

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
18 DILESHWARI C102454185963 <Aadhaar Based> xxxxxxx6287 2,935.00
SANJAYKUMAR
WATTI
19 GAYATRI C102454185919 <Aadhaar Based> xxxxxxx0738 2,975.00
ATMARAM
SHENDE
20 GAYATRI C102454185964 <Aadhaar Based> xxxxxxx5092 3,110.00
MUKESH
RAHANGADALE
21 GITESHWARI C102454185965 <Aadhaar Based> xxxxxxx8838 2,750.00
KHETINDRA
PATLE(ASHA
S.SEVIKA)
22 HARIKANTA C102454185892 <Aadhaar Based> xxxxxxx6541 3,970.00
RAJESH
KARANJEKAR
23 HARSHILA C102454185966 <Aadhaar Based> xxxxxxx5511 2,680.00
ROSHANLAL
BISEN
24 HITESHWARI C102454186006 <Aadhaar Based> xxxxxxx3324 4,730.00
RAJKUMAR
SHYAMKUWAR
25 INDRAKALA C102454185920 <Aadhaar Based> xxxxxxx2580 3,990.00
ANIL RANGARI
26 JAISHILABAI C102454185968 <Aadhaar Based> xxxxxxx2473 3,235.00
GYANESHWAR
CHOUDHARY
27 JANA MOHAN C102454185921 <Aadhaar Based> xxxxxxx3915 2,810.00
KARKATE
28 JANKI C102454185922 <Aadhaar Based> xxxxxxx5425 3,005.00
MEGHSHYAM
MOTGHARE
29 JYOTI PREMLAL C102454185969 <Aadhaar Based> xxxxxxx0835 3,030.00
RAHANGADALE
30 KALPANA ANIL C102454185923 <Aadhaar Based> xxxxxxx9793 3,380.00
MESHRAM
31 KALPANA ANIL C102454185970 <Aadhaar Based> xxxxxxx4092 3,415.00
WALDE
32 KALPANA C102454185924 <Aadhaar Based> xxxxxxx4325 2,700.00
GANRAAJ
DHAMGAYE
33 KALPANA C102454186018 <Aadhaar Based> xxxxxxx8263 2,755.00
TULSHIRAM
DESHMUKH
34 KANTABAI C102454185893 <Aadhaar Based> xxxxxxx1670 3,760.00
GANESH TEKAM

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
35 KAVITA C102454185971 <Aadhaar Based> xxxxxxx7395 2,860.00
HARIRAM
KATHLEWAR
36 KESAR C102454186017 <Aadhaar Based> xxxxxxx9040 3,385.00
DEVENDRA
SONWANE
37 KHEMLATA C102454185972 <Aadhaar Based> xxxxxxx0333 4,890.00
MUKESH
AWASARE
38 KIRAN DHANRAJ C102454185925 xxxxxxxxxxxx1906 BKID0009200 3,595.00
TUMSARE
39 KUNDLATA C102454185926 <Aadhaar Based> xxxxxxx7809 4,100.00
RADHESHYAM
MUNESHWAR
40 KUSAMI C102454185894 <Aadhaar Based> xxxxxxx4091 3,210.00
KAILASH
BHOYAR
41 LALITA C102454185927 <Aadhaar Based> xxxxxxx3442 2,830.00
RAMESHWAR
SHAYMKUWAR
42 LATESHWARI C102454185928 <Aadhaar Based> xxxxxxx0028 3,465.00
MANOHAR
RAHANGDALE
43 MADHURI C102454185929 <Aadhaar Based> xxxxxxx3601 4,560.00
ZANAKRAM
NAGRIKAR
44 MAMTA C102454185899 <Aadhaar Based> xxxxxxx2612 4,365.00
DEVENDRA
KATRE
45 MAMTABAI C102454185900 <Aadhaar Based> xxxxxxx2010 2,820.00
MOHANLAL
BIBINAHAKE
46 MANGALA C102454185930 <Aadhaar Based> xxxxxxx9153 3,465.00
BHARATRAM
GAIDHANE
47 MANGALA C102454185973 <Aadhaar Based> xxxxxxx3625 3,855.00
MALKAN
BOPCHE
48 MANGLA C102454185931 <Aadhaar Based> xxxxxxx1045 3,615.00
GOPICHAND
BAHEKAR
49 MEENAKSHI C102454185975 <Aadhaar Based> xxxxxxx3837 3,350.00
CHHANESHWAR
CHOUDHARY
50 MEERA C102454185933 <Aadhaar Based> xxxxxxx0344 2,790.00
CHANDRAPRAK
ASH TAWADE

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
51 MINA C102454185932 <Aadhaar Based> xxxxxxx8644 4,450.00
BHUMESHWAR
THAKUR
52 MINA C102454185901 <Aadhaar Based> xxxxxxx3221 2,890.00
DILESHWAR
VAIRAGADE
53 MINAKSHI C102454185934 <Aadhaar Based> xxxxxxx2467 3,390.00
DIGESHWAR
TEMBHRE
54 MINATAI C102454185902 <Aadhaar Based> xxxxxxx5145 3,595.00
BHOJRAJ
BAWANTHADE
55 Miss. SARITABAI C102454185989 <Aadhaar Based> xxxxxxx1886 3,480.00
DARWADE
56 MITALI DHIREN C102454185935 <Aadhaar Based> xxxxxxx3720 4,070.00
MAHAPATRA
57 Mrs. INDIRA C102454185967 <Aadhaar Based> xxxxxxx0539 4,775.00
CHANDRASHEK
HAR DONGARE
58 Mrs. C102454185974 <Aadhaar Based> xxxxxxx3036 3,080.00
MANNUBAI
SANJAY
SHAHARE
59 Mrs. NITA C102454186007 <Aadhaar Based> xxxxxxx1227 4,205.00
GYANIRAM
BOPCHE
60 Mrs. PRAMILA C102454186008 <Aadhaar Based> xxxxxxx5064 4,835.00
KIRANKUMAR
SHAHARE
61 Mrs. REKHA C102454186009 <Aadhaar Based> xxxxxxx1639 3,545.00
DHALCHAND
HARINKHEDE
62 Mrs. SASHIKALA C102454185990 <Aadhaar Based> xxxxxxx2234 3,690.00
GIRISH
BRAMHANKAR
63 Mrs. SHARDA C102454186015 <Aadhaar Based> xxxxxxx8147 2,645.00
RAMESHWAR
WADHAI
64 Mrs. SHOBHA C102454186010 <Aadhaar Based> xxxxxxx4089 3,165.00
GYANIRAM
FUNDE
65 Mrs. YOGITA C102454185909 <Aadhaar Based> xxxxxxx0314 3,960.00
RAJENDRA
SURYAWANSHI
66 Ms C102454185983 <Aadhaar Based> xxxxxxx8259 3,405.00
REKHARAHULM
ESHRAM RAHUL
MESHRAM

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
67 MUNESHWARI C102454185976 <Aadhaar Based> xxxxxxx3357 3,665.00
TILAKCHAND
BAGHELE
68 NANDINI C102454185936 xxxxxxxxxxxx2234 BKID0009200 3,280.00
SURENDRA
GONDANE
69 NIRMALA C102454185888 <Aadhaar Based> xxxxxxx3504 3,060.00
ISHWARDAS
BHAVE
70 PANCHFULA C102454185937 <Aadhaar Based> xxxxxxx6215 4,360.00
RAGHUNATH
BAWANE ASHA
SEVEKA
71 PARVEEN C102454185938 <Aadhaar Based> xxxxxxx4716 3,815.00
NASIM SHEIKH
72 PRABHAVATI C102454185977 <Aadhaar Based> xxxxxxx9505 3,640.00
CHANGESHWAR
BAGHELE
73 PRAMILA C102454185939 <Aadhaar Based> xxxxxxx1194 4,455.00
ISHWAR BISEN
74 PRAMILA C102454185978 <Aadhaar Based> xxxxxxx6175 3,385.00
KAMALCHAND
FUNDE
75 PRAMILA C102454185979 <Aadhaar Based> xxxxxxx1417 4,130.00
TILAKCHAND
RAHANGDALE
76 PRATIMA C102454185903 <Aadhaar Based> xxxxxxx5178 3,810.00
RAJKUMAR
PATLE
77 PREMLATA C102454185980 <Aadhaar Based> xxxxxxx2485 3,630.00
SANTOSH
BHANDARKAR
78 PUSHPA BISAN C102454185940 <Aadhaar Based> xxxxxxx0387 4,110.00
GIRHEPUNJE
79 PUSHPA C102454186013 <Aadhaar Based> xxxxxxx7551 3,005.00
TEJRAM
BAHEKAR
80 PUSHPABAI C102454185941 <Aadhaar Based> xxxxxxx0097 4,100.00
RAMLAL
TURKAR
81 PUSTAKALA C102454185904 <Aadhaar Based> xxxxxxx7014 4,115.00
RAJESH
SHAHARE
82 PUSTAKALA C102454185981 <Aadhaar Based> xxxxxxx2712 2,870.00
ZUMAKLAL
PATLE

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
83 RANJANA C102454185942 <Aadhaar Based> xxxxxxx5592 3,375.00
CHAUKLAL
TEMBHARE
84 RANJANA C102454185943 <Aadhaar Based> xxxxxxx8500 3,070.00
PANCHAM
MANKAR ASHA
SEVIKA
DAHEGAON
85 RATNA ISHWAR C102454185982 <Aadhaar Based> xxxxxxx1892 6,140.00
SURYAWANSHI
86 RATNAKALABAI C102454185944 <Aadhaar Based> xxxxxxx1392 3,080.00
DHARMRAJ
KAPSE
87 RINA BHASKAR C102454185945 <Aadhaar Based> xxxxxxx5945 3,855.00
BRAMHANKAR
88 RINA VINOD C102454185984 <Aadhaar Based> xxxxxxx3375 3,960.00
MADIVI
89 SANGITA C102454185985 <Aadhaar Based> xxxxxxx5174 3,850.00
JAGANNATH
DONONDKAR
90 SANGITA RAJAN C102454185986 <Aadhaar Based> xxxxxxx3833 6,170.00
RAHANGDALE
91 SANGITA C102454185946 <Aadhaar Based> xxxxxxx4056 2,800.00
TILAKRAM
BAGDE
92 SAPNA C102454185987 <Aadhaar Based> xxxxxxx3216 3,880.00
SHATRUGHNA
RAHANGDALE
93 SARITA C102454185905 <Aadhaar Based> xxxxxxx2361 4,560.00
LALITKUMAR
MANKAR
94 SARITA C102454185988 <Aadhaar Based> xxxxxxx5884 3,750.00
MIKTANAND
RAHANGDALE
95 SATYBHAMA C102454185991 <Aadhaar Based> xxxxxxx6160 3,450.00
ASHOK KAWRE
96 SATYBHAMA C102454185947 <Aadhaar Based> xxxxxxx5547 2,945.00
TURSIRAM
PATHODE
97 SAVITA TEKRAJ C102454185948 <Aadhaar Based> xxxxxxx3970 3,630.00
HEMNE
98 SHAKUNTALA C102454185949 <Aadhaar Based> xxxxxxx3095 4,035.00
DINESH FUNDE
99 SHAKUNTALABA C102454185950 <Aadhaar Based> xxxxxxx2518 5,660.00
I PARASLAL
SIHORE

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
100 SHANTABAI C102454185951 <Aadhaar Based> xxxxxxx5616 4,035.00
TILAKCHAND
SINHAMARE
101 SHARADA C102454185992 <Aadhaar Based> xxxxxxx9976 4,780.00
PADMAKAR
KHOBRAGADE
102 SHOBHA C102454185993 <Aadhaar Based> xxxxxxx4732 6,230.00
GAVARACHAND
BISEN
103 SINDHU DHURV C102454185952 <Aadhaar Based> xxxxxxx5410 3,365.00
DESHKAR
104 SITABAI C102454186011 <Aadhaar Based> xxxxxxx4692 3,080.00
RAMKUMAR
SHARMA
105 SONULA C102454185995 <Aadhaar Based> xxxxxxx9371 4,035.00
SHIVPRASAD
RANE
106 SUNANDA C102454185889 <Aadhaar Based> xxxxxxx8955 3,720.00
DEVENDRA
ROKADE
107 SUNITA EKNATH C102454185906 <Aadhaar Based> xxxxxxx6392 4,025.00
PARDHI
108 SUNITA C102454185996 <Aadhaar Based> xxxxxxx5911 3,010.00
NANDKISHORE
MANKAR
109 SUNITA NIRAJ C102454185997 xxxxxxxxxxxx1861 BKID0009200 5,360.00
KHOBRAGADE
110 SUNITA SACHIN C102454185998 <Aadhaar Based> xxxxxxx1872 3,005.00
BHAVE
111 SUNITA C102454185999 <Aadhaar Based> xxxxxxx3793 3,550.00
UMASHANKAR
BAHEKAR
112 SUSHEELA C102454186000 <Aadhaar Based> xxxxxxx8278 4,425.00
RAMESH
DONODE
113 SUSHILA C102454185994 <Aadhaar Based> xxxxxxx1264 3,200.00
CHANDRASHEK
HAR MESHRAM
114 TARA KUNDAN C102454185953 <Aadhaar Based> xxxxxxx0447 3,410.00
SAKHARKAR
115 TOWINA ANIL C102454186001 <Aadhaar Based> xxxxxxx6131 5,120.00
SAHARE
116 TURSABAI C102454186016 <Aadhaar Based> xxxxxxx1839 5,540.00
BENIRAM
LANJEWAR

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 ANNEXURE -I
(All page to be stamped and initial and last page to be signed in FULL with stamp)

Payment Advice No.: C102454185898

Sr.No. Name of PFMS Txn ID Account IFSC/IIN/MICR Aadhaar Amount(In
Beneficiary Number Code Number Rs.)
117 UMAKANTA C102454185890 <Aadhaar Based> xxxxxxx2271 3,700.00
MANIKRAM
TEMBHARE
118 URMILA C102454186002 <Aadhaar Based> xxxxxxx3917 5,475.00
BUDHRAM
GAIDHANE
119 URMILABAI C102454185907 <Aadhaar Based> xxxxxxx1749 3,395.00
RADHELAL
CHOUDHARI
120 USHA C102454185954 <Aadhaar Based> xxxxxxx9031 3,420.00
RAMGOPAL
PATLE
121 VAISHALI C102454185955 <Aadhaar Based> xxxxxxx3500 3,210.00
DINESH
BAWANTHADE
122 VANDANA C102454186012 <Aadhaar Based> xxxxxxx1164 2,815.00
SANTOSH
BORKAR
123 VANITA C102454185908 <Aadhaar Based> xxxxxxx6280 4,435.00
TARACHAND
BISEN
124 VATSALA C102454185956 <Aadhaar Based> xxxxxxx7766 4,160.00
SHRIRAM
TURKER
125 VIDHYA C102454186003 <Aadhaar Based> xxxxxxx2113 3,380.00
SANGHDEEP
SHENDE
126 VIMAL VIJAY C102454186004 <Aadhaar Based> xxxxxxx8589 3,550.00
SONVANE
127 YASHODHA C102454186005 <Aadhaar Based> xxxxxxx2924 4,670.00
ASHOK FUNDE
Total Amount(Rs) 4,71,960.00

Please acknowledge and do the needful as prescribed by bank to complete transactions.

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