ANNEXURE A: CONFIRMATION OF RECEIPT

On handing over each Asset to a User, the SERVICE PROVIDER shall have the following
Confirmation of Receipt signed from such User. The SERVICE PROVIDER shall maintain a record
of these Confirmation of Receipt documents and shall provide the same to the Company upon
request.

IMEI No. :

Name of User :

Name of Agency : Aadhan/TMI etc.

Agency Employee code :

Date of Handing Over to User : DD/MM/YYYY

CONFIRMATION OF RECEIPT

I <Name of User>, hereby confirm that I am in receipt of <IMEI Number>, Samsung TAB A
(SM-T355Y) from <Name of Agency> on <Date of Receipt>.

I shall also abide by all laws, rules and regulations and company policies applicable to the use
of this Asset. I further confirm that I will not use this Asset for any purpose other than for which
it has been specifically handed over to me. In the event of separation from the company for any
reason, I am obliged to return the asset back in good condition to the company.

In the event, of any damage to the asset or inability to return the asset back to the company, I
am liable to pay Rupees Twelve Thousand as cost of the asset and the same will be adjusted
against any dues to me and <Name of Agency> can take lien of my Provident Fund to recover
the full amount.

__________________ ___________________
User SERVICE PROVIDER

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