I, ___________________(seller’s full name)________________________________ of____________________(seller’s full address)________________________________ the owner/seller of _________________(full description of goods and serial/model number)_____ hereby declare that I sold the above mentioned goods to ____________(name of buyer)______ for the amount of _________________ on ____________________. I acknowledge receipt of cash / cheque no. ________ dated _____________ for the amount of ______________ being full and final payment for the above mentioned goods.

name, signature and date