FORM III - ACKNOWLEDGEMENT SLIP - Prevention of Money-Laundering (The Manner of Forwarding A Copy of The Order of Provisional Attachment of Property Along With The Material, And Copy of The Reasons Along With The Material In Respect of Survey, To The Adjudicating Authority And Its Period of Retention) Rules, 2005

FORM III [See sub-rule (5) of rule 3 and sub-rule (5) of rule 4] ACKNOWLEDGEMENT SLIP Serial Number................... Received a sealed envelope bearing No........dated............... from ................ [Director or the authorized officer or the authority from whom received as the case may be] on .......[date] at ...........[time] Signature of the Adjudicating Authority/designated officer of the office of Adjudicating Authority. ................................ Name of the Adjudicating Authority/designated officer of the office of Adjudicating Authority. [Office seal] To ................................................... [Director or the authorised officer or the authority as the case may be] Address:.................................... ...................................................... ......................................................