APPENDIX - 22-A

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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.

Place: Official Seal/ stamp

Signature of the domestic supplier. Name in block letters Designation Full official address 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/** 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

(Appendix 22A has been amended vide P.N. No.22/2004, DT. 08/11/2004)

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[OLD-
APPENDIX - 22-A

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BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES

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NOTE: PLEASE SEE CHAPTER 4,5 AND 8 OF THE POLICY AND CHAPTER 4, 5 AND 8 OF THE PROCEDURE.

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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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