I Sri KUWAR LUGUN S/O: - SAMUEL LUGUN, Residence of Village – RANGAMATI,

GP-NUAGAON, Block- Kutra, Dist-Sundargarh, Received from Vendor Aszad Raza

GSTIN: - 21EMUPR7131H1ZP For IMP OF ROAD FROM RANGAMATI TIDUPARA TO
GURDIAPARA Towards the Following payments of

Worksite facilities/Creche/Drinking water/First aid

A. Chair (5 Nos) RS-850/-

B. BUCKET & Mug (2 Nos) RS-500/-
C. Mat (2 Nos) RS-800/-
D. Tarpaulin RS-600/-
E. Sanitizer (6 Nos) RS-900/-
F. Dettol Handwash (5 Nos) RS-1050/-
G. FIRST AID BOX RS-800/-
….………………………………………………………..

TOTAL AMOUNT RS -5500/-

SIGNATURE

I Sri KUWAR LUGUN S/O: - SAMUEL LUGUN, Residence of Village – RANGAMATI,

GP-NUAGAON, Block- Kutra, Dist-Sundargarh, Received from Vendor Aszad Raza
GSTIN: - 21EMUPR7131H1ZP For IMP OF ROAD FROM RANGAMATI TIDUPARA TO GURDIAPARA
Towards the Following payments of

1. Miscellaneous/ contingencies Charges RS-5400/-

……………………………………………………..

TOTAL AMOUNT RS -5400/-

SIGNATURE