APPENDIX 22 B

BANK CERTIFICATE OF PAYMENTS FOR DOMESTIC SUPPLIES

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:		: ...........................................
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