Acknowledgement Form - Asset Receipt

Employee or Consultant Name: __________________________________________________

Designation: __________________________________________________

Site/Location: __________________________________________________

Date Received: __________________________________________________

Issued By: __________________________________________________

Type of Device (please circle): Cell Phone Computer Laptop WIFI Router

Other:_______________________

Please circle if any of the following are issued: Charger Cable Only Case
Laptop Bag Other:_______________________

Serial Number: ____________________________________________________

Make and Model: __________________________________________________

I hereby confirm that:

1. I have received the above mentioned asset/s. Furthermore, I have ensured that it/they is/are in good
working order and I hereby confirm that I understand that I am responsible for its/their safekeeping from
this point forward. I understand that this/these asset/s belong/s to GRS and is /are under my possession
for carrying out official duties. I hereby assure that I will take care of all asset/s issued to me to the best of
my ability. Upon resignation/termination/end of contract/end of consultant agreement that I’ll
Immediately handover assets/s in good working condition.
2. If not in good working order, I understand that the organisation shall endeavour to obtain quotation for
fixing the devices or buying a replacement, whichever option that will be best suitable. The cost thereof
will be deducted from my final salary/invoice payable.
3. If I encounter any issues during the course of employment/contract, I will contact my manager, and the
HR Team (osepato@grassrootsoccer.org) to ensure that these device/s are fixed as required.

Employee Signature: ________________________________ Date: __________

Issuer Signature: ___________________________________ Date: __________

Please scan and email this form to osepato@grassrootsoccer.org when completed. If you have any queries please use the same email
provided. Thank You!