Appendix 22 B
Bank Certificate
of Payments for Domestic Supplies
[Appendix 22B amended by 71-PN(RE)/02.09.2008]
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 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.
** 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 |
:
................................. |
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
***Alternative Bank Certificate to be furnished
by EOU, in case deemed export benefits are claimed on disclaimer basis.
Bank’s Certificate
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 Bankers
Branch and City
Official Stamp
***
This alternative Bank Certificate will need to be furnished alongwith
domestic supplier certificate, as above