Name

:___________________________________________________________________

Designation

:___________________________________________________________________

ID No

:___________________________________________________________________

Department

:___________________________________________________________________

Date

IT Section:
Desktop / Laptop

Model No

Condition

: New / Used

Additional Components : a) Bag b) Mouse C) USB Modem etc.

Date of Issue

Communication Section:
Mobile Set (Model)

Condition: New/ Used

SIM Card

Any Other item:

In Case of Other Material:

Description of Items/Material

Quantity

Date if Issue

Date of Return

The above mentioned items/material/car/vehicle/others are handing over/taking over in front of the
following witnesses.

_______________
Handed Over By
Name:
Desig:
ID No:
Witness:
1.
2.

______________
Taken Over By
Name:
Desig:
ID No: