Goods/Items Received by:

Name: ______________________________ Father’s Name: _________________________________

Designation: _____________________________________________________________________

Organization / Institution: ___________________________________________________________

Address Office: ______________________________________________________________

Contact # Office ______________________ Cell # ______________________________________

E-Mail: ______________________________

Received From: _________________________ Designation: _______________________________

Department: ________________________________________   Date: _____ /______ /_________

Terms and Conditions: Please note safety of received goods is the sole responsibility of the recipient. All items must be returned back in the same condition as received. Any loss or theft will be the responsibility of the recipient.

Received By                                                                                        Issued By

_______________                                                                              ______________________

Sign____________                                                                             Sign__________________