Signature Not Verified

Consignee Receipt & Acceptance Certificate

Digitally Signed
Vishal Dani CRAC No: GEMCRAC-1-511687799935607-1
National High Speed Rail Corporation Limited Office no 1001 to 1006 10th CRAC Date: 18-Aug-2022
floor Swastik Universal-B Dumas Road Rundh Surat, SURAT, GUJARAT-
395007

Contract No: GEMC-511687799935607 GeM Invoice No: GEM-22182452

Contract Date: 08-Aug-2022 GeM Invoice Date: 18-Aug-2022
PRC Date: 11-Aug-2022

Bill To Shipped By

National High Speed Rail Corporation Limited Office no 1001 to 1006 10th
floor Swastik Universal-B Dumas Road Rundh Surat, SURAT, GUJARAT-
395007
PATEL INFOTECH
Type: SPV/Sec-8 Company
Ministry: Ministry of Railways PATEL INFOTECH, SURAT, GUJARAT - 395009
Department: NA
Organisation Name: N/A
Office Name: Delhi

Contract Item Details

# Item Description Model Ordered Quantity Unit Price per Unit inclusive of all Duties and Taxes (in INR)

1 Konica Minolta TN323 Class OEM TN 323 2 pieces 3977.0

Total Order Value (in INR) 7954.0

CONSIGNMENT DETAILS

Supplied Received Accepted Rejected Reason for Price per Unit inclusive of all
S.No Item Description
Qty(Nos.) Qty Qty Qty rejected items Duties and Taxes (in INR)

Konica Minolta
1 2 2 2 0 3977.0
TN323 Class OEM

Total Received Order Value (in INR) 7954.0

BOOK ENTRY DETAILS

The goods/services have been satisfactorily received and the entry has been made in the stock keeping register at page no. 18 at serial no. 8.

Note: This is a computer generated statement to generate e-bill by the buyer for making payment.
Ink Signed Signatures are not required in System Generated Documents.