Services supplied Details (*) = required fields.
  Service from Date Date of Birth
(DD/MM/YYYY)		 Service to Date Date of Birth
(DD/MM/YYYY)
  Service Type Memo
  Particulars Amount
  Annual Payment Amount (Gross) K1
  Service Benefit available days for the Period K2
  Days the service benefit was not available during the benefit period K3
  Actual No.of days the service benefit was made available (K2 minus K3 ) K4
  Prorated Annual Payment amount for actual benefit period ( K1 * K4 / 365) K5
  Amount made good or amount already subjected to tax K6
  Total Cash Equivalent Amount ( K5 minus K6 ) K
 

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