APPENDIX - 22A
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 | :......................................... |
BANK"s CERTIFICATE
This is to certify that we have received the amount mentioned in column 7 against invoice mentioned in column 1 above.
(Signature of the Bankers)
Full address of the Bankers
_______________________________________
Branch and City _______________________
Official Stamp.
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