Annexure-VIIClaim Form for Marketing Development Assistance For Participation in Trade fairs/Exhibitions/BSM/ Trade Delegation abroad Ref No……………………………………………………………. Date:.............................................
Undertaking and DeclarationI/We hereby solemnly undertake/declare that the particulars stated above are true and correct to the best of my/our knowledge and belief. No other application for claiming assistance for this participation and/or travel cost has been made or will be made in future against purchase covered by the application. Any information, if found to be incorrect, wrong or misleading, will render/us liable to rejection of our claim without prejudice to any other action that may be taken against us in this behalf. If as a result of scrutiny any excess payment is found to have been made to me/us, the same may be adjusted against any of the subsequent claims to be made by my/our firm or in the event no claim is preferred, the amount overpaid will be refunded by me/us to the extent of the excess amount paid. Name in Block Letters : Designation : Name of the Applicant : Firm : Place: Signature Date: Company Seal Annexure - VIIIChartered Accountant Certificate (To be given on the CA’s letter head) I/We hereby confirm that I/We have examined the claim papers, books of account and the prescribed documents in respect of the claim of M/s. and hereby certify that:
Neither I/We nor any of our partners is a partner/Director or an employee of the above named entity or its associated concerns. I fully understand that any submission made in this certificate if proved incorrect or false, will render me/us liable to face any penal action or other consequences as may be prescribed in the law or otherwise warranted. Signature & Stamp/seal of the Signatory______________________________ Name__________________________________________________________ Membership No._________________________________________________ Full address_____________________________________________________ Name and address of the Institution where registered. Date: Place: (TO BE PREPARED ON THE COMPANY LETTER HEAD) Bill for Payment Name of the Firm Address Approval letter No………………………………Date: ………………………… Event (Please Tick which ever Relevant): 1. Participation in trade fair/BSM abroad
Event particulars: _______________________
PRE-RECEIPT Received with Thanks a sum of Rs…………………………………Rupees _____________________________ __________________________________________________ being the MDA Grant towards (Give the name of the event with date) _________________ vide cheque No…………………………………dated ……………………………………… AFFIX RUPEE ONE REVENUE STAMP HERE SIGNATURE NAME & DESIGNATION WITH OFFICE SEAL NOTE: PLEASE CALCULATE THE AMOUNT OF CLAIM STRICTLY AS PER GUIDELINES. *(Cheque No. and amount will be filled by ITPO at the time of issuance of Cheque). FORMAT OF TOUR REPORT (ON YOUR COMPANY LETTER HEAD) Following points should invariably be covered in the Tour Report:
(IN CASE, ORIGINAL TICKET IS LOST, THEN THE DECLARATION GIVEN BELOW IS TO BE SUBMITTED)
I/WE SOLEMNLY DECLARE THAT THE PARTICULARS SUBMITTED WITH ABOVE CLAIM ARE CORRECT. I/WE HEREBY UNDERTAKE THAT MY SELF AND THE COMPANY ARE ACCOUNTABLE AND RESPONSIBLE FOR ANY INCORRECT INFORMATION GIVEN IN THE ABOVE CLAIM. IN THE EVENT OF ANY WRONG INFORMATION BEING OBSERVED BY THE ITPO OR THE MDA COMMITTEE OR ANY OTHER GRANTEE ORGANISATION IN THE ABOVE CLAIM, I/WE SHALL BE LIABLE TO REFUND THE MDA GRANT RELEASED TO US AGAINST THE ABOVE CLAIM. I/WE AGREE TO PROVIDE ANY ADDITIONAL DOCUMENT(S)/ INFORMATION TO THE ITPO PERTAINING TO OUR ABOVE CLAIM AS AND WHEN SOUGHT BY THE ITPO. Signature with Name & Designation Affix Rubber Stamp |