APPENDIX 22B
- Document type
- Procedure
- Reference no.
- A
- Dated
BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES
BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES
To _________________________________(Name and address of Regional 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 | ||||
| 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.
** FOR value actual realized and date against supplies made are to be given in all cases except where consignment has been sent against irrevocable inland letter of credit in case of status holders/ confirmed irrevocable inland letter of credit in case of others
We further declare that the aforesaid particulars are correct.
| Signature of the domestic supplier | : ........................................... | |
| Name in block letters |
: ........................................... : ........................................... |
|
|
Place: Date: |
Designation |
: ........................................... |
| Full official address | : ........................................... | |
| Official Seal/stamp | Full Residential address | : ........................................... |
This is to certify that we have received the amount mentioned in Column 7 against invoice mentioned in Column 1 above/details mentioned in Column 5 above (Please Strike out one of the options).
(Signature of the Bankers)
Full address of the Bankers
Branch and
City
Official Stamp
(***) Alternative Bank Certificate to be furnished by EOU, in case deemed export benefits are claimed on disclaimer basis.
This is to certify that the amount mentioned in Col. 7 against invoice mentioned in Col. 1 above/details mentioned in Col.5 above (please strike out one of the options), has been debited from the account of EOU, for supplier mentioned above.
(Signature of the Bankers)
Full address of the Banker(s)
Branch and City
Official Stamp
*** This alternative Bank Certificate will need to be furnished along with domestic supplier certificate, as above.