APPENDIX - 22A
- Document type
- Procedure
- Dated
BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES
BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES
NOTE: PLEASE SEE CHAPTER 4,5 AND 8 OF THE POLICY AND CHAPTER 4, 5 AND 8 OF THE PROCEDURE.
To ______________________________ (Name and address of Licensing Authority). We ________________________ (Name and address of the domestic supplier) hereby declare that we have received payment through banking channel in respect of supplies given hereunder.
| Invoice | Description of goods as given in the invoice | Details of payment/ advance payment received | Date of issue of this Certificate | ||||
| No. | Date | FOR value | Cheque /DD No./ *Bank Ref. No. | Date | Amount | ||
| [1] | [2] | [3] | [4] | [5] | [6] | [7] | [8] |
* The Bank Reference Number would be applicable for documents routed through bank & payments released through banking channels.
We further declare that the aforesaid particulars are correct.
| Signature of the domestic supplier. | :......................................... | |
| Name in block letters | :......................................... | |
| Place: | :......................................... | |
| Designation | :......................................... :......................................... | |
| Full official address | :......................................... | |
| Official Seal/ stamp | Full Residential address | :......................................... |
(Signature of the Bankers)
Full address of the Bankers
_______________________________________
Branch and City _______________________
Official Stamp.