FORM C

For Adjustment payment

Deptt. Code CINT, S.NO.__CINT/2016-17
INDIAN INSTITUTE OF TECHNOLOGY, DELHI
SUMMARY SHEET
Name of (Buyer) Dr. J. Bijwe
Advanced Amount USD. 359
Employee Code: 15699
Project Code: RP
Department / Section: ITMMEC Sanction No. / S.O.No
Form C No:
Budget Head: Consumable .
S.No.

Name, Address of Supplier

Memo
No. & Date

Description of
items

Qty
(kg)

Rate
(USD)

Amount
(USD)

Total
(USD)

1.

Teijin frontier co. ltd, comodio

shiodome, 2-14-1,
higashishimbashi, minato-ku,
Tokyo 105-0021, japan
Invoice no. 702IN1,
Order no.
FES(211)/ITM/15/SP-1/3192
Date: 22.4.2016

Chopped carbon fiber

HT C702 6mm

2 kg

108.00

216.00

359.00

Milled carbon fiber

HT M100 40 MU

1 kg

143.00

143.00

Three hundred fifty nine USD only

USD 359

Certified that the items on this sheet have been For Adjustment payment
1. Consumable
procured by me in good conditions
Balance now payable nil
On A/C ofAlready paid 359 USD
(Amount In words)
( Three hundred fifty nine USD only)
Sign. of Buyers
Name (s): Dr. J. Bijwe
E. Code (s): 15699
Sign of Store keeper

Sign PI
E Code:15699

HOD/ Nominee to sign after ensuring that S.NO. As put at the top of the previous page is in the order.

Sign. Of HOD
Or Nominee

IRD A/Cs/Main Accounts/ Audit

ISSUE RECORD
Date

22.4.2016

Particulars of Items

Quantity

Balance

Recd.

Issued

Chopped carbon fiber HT C702 6mm

2 kg

2 kg

Milled carbon fiber HT M100 40 MU

1 kg

1 kg

Nil

Issued to sign
& E. Code