Name of the Agency *

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E-Mail

Mobile Number

District *

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Block *

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Police Station *

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Name of Village *

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Nature of Work *

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Name of the Work *

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Name of the Fund Source *

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NIeT No. *

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Date of Niet *

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Work Order Memo No *

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Date of Work Order *

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Work Order Amount *

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Date of Completion of Work *

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Final Bill amount (in Rs.) *

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