1148-6 Avenue de la Libération, Quartier Golf les Battants

Commune de Lubumbashi, Ville de Lubumbashi

Province du Haut-Katanga, République Démocratique du Congo
www.ivanhoemines.com

ACKNOWLEDGEMENT OF RECEIPT OF I.T. EQUIPMENT

Allocation: #37466
Item Description Serial Number Status
Company ID / Asset
Number:
Computer name:
Computer Type:
Operating System:
System Manufacturer:
System Model:
BIOS:
Processor:
RAM Memory:
Hard Drive Capacity:
Laptop case
Mouse
External screen HP M24f FHD Monitor 3CM2223FNL
External Keyboard
Memory Stick
UPS
Docking Station HP USB-C Dock G5 EURO 5CG302ZHT3
Desk Phone
Mobile Phone
Radio
Other 1
Other 2

Approvals:
Name Job Title Signature Date
Technician Erudit Kyungu IT Support Technician 28/08/2023
Supervisor Ruffin Mudimbi Sr. Officer, IT Site Support 28/08/2023
End User Paul Tshendesa Officer Warehousing 28/08/2023

By signing this form, I agree that I am responsible for the following:

1. I will use the equipment in the manner intended and will keep it in a safe place on\off duty.
2. I will be responsible for any damage done (excluding normal wear and tear)
3. Upon separation from the Company, I will return the item(s) issued to me in proper working order (excluding
normal wear & tear)
4. I will replace any items issued to me that are damaged or lost at my expense
5. I authorize a payroll deduction to cover the replacement cost of any item issued to me that is not returned for
whatever reason, or is not returned in good working order (excluding normal wear & tear or otherwise specified
and approved by company management).

ID NAT: 6-118-N37233J L’SHI/RCCM: 14-B-1683 NIF: A0901048A CAPITAL SOCIAL: 500.000 USD

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