GOVERNMENT OF WEST BENGAL

FOOD AND SUPPLIES DEPARTMENT

CERTIFICATE ON PROOF OF RECEIPT/DELIVERY OF PADDY

This is certify that ___________________________ Quintal of FAQ paddy(CP/SP) which was procured by

______________________________________________________________________________________________________________
( Name of CPC) empanelled under D.C.F&S, HOOGHLY, directly from farmers at MSP on __________________
(Date) has been delivered to MADINA RICE MILL PVT. LTD., BATANAL, ARAMBAGH, HOOGHLY, 712615
(W.B.) (name of rice mill) on __________________________ (Date) in good condition. Corresponding Muster Roll
No._________________________________________________ Dated __________________________ & Paddy Challan
No._________________________________________________ Dated ___________________________

Signature of Purchase Officer Signature of Disbursement Officer

(With seal) (With seal)

The said quantity of paddy has been received on _________________________(date)

and total progressive quantity receive as on date _________________________ quintals
from the above said CPC (CP/SP). The said quantity of paddy has been shown in
the Stock Register of paddy of the rice miller and ___________________ quintals of
paddy which is shown as closing balance including above stock has found physically at the
premises of the said rice mill.

_____________________________

Signature of rice miller/his/her

Authorizes representative (with seal)
Name: Signature of the Tagged
Inspector (F&S)
(With seal)
Date: