Form of Utilization Certificate
1. Certified that out of Rs.____________of grantsin- aid sanctioned during the year ________in favour of ________under this Ministry/Department Letter No. given in the margin and Rs._______on account of unspent balance of the previous year, a sum of Rs._______has been utilized for the purpose of _________for which it was sanctioned and that the balance of Rs._______remaining unutilized at the end of the year has been surrendered to Government (vide No.________________, dated _________)/will be adjusted towards the grants-in-aid payable during the next year _________.

2. The Utilization Certificate should also disclose whether the specified, quantified and qualitative targets that should have been reached against the amount utilized, were in fact reached, and if not, the reasons thereof. They should contain an output-based performance assessment instead of input-based performance assessment.

3. Certified that I have satisfied myself that the conditions on which the grants-in-aid was sanctioned have been duly fulfilled/are being fulfilled and that I have exercised the following checks to see that the money was actually utilized for the purpose for which it was sanctioned. Kinds of checks exercised


1. ________________________________________________________________________________

2. ________________________________________________________________________________

3. ________________________________________________________________________________

4. ________________________________________________________________________________

5. ________________________________________________________________________________

Signature_________________
Designation_________________
Date_________________