Invoice No:
Installation / Acceptance Certificate
ATM ID -
Customer Name : Support Location :
Installation Site Details Custodian / Linked Branch Details
PIN Code--------
Landmark Contact Person Name :
Tel.No. Tel.No. / FAX No.
FLM Agency Name & Tel.No. Email :
Branch Manager Tel. No. Office Timing / Weekly OFF
Hardware Details Accessories Description ( Third Part Products )
1. Serial Number 1. Access Lock (Make/Sl.No.)
2. Model /Class 2. VSS ( Make/Sl.No. )
3. Motherboard 3. Alarm Panel (Make/Sl.No.)
4. Memory / HDD 4. PC (Make/Sl.No.)
5. Currency Dispenser 5. UPS (Make/Sl.No.)
6. Printer Type 6. AC (Make/Sl.No.)
7. Card Reader Type 7. ATM IP Address
8. Depository(Yes/No) 8. EJ Agent Name & Version
9. Combination Lock 9. EJ Docket Number
10. EPP Sl.No. 10. MAC Address
Software & Version Details :-
Training Details :- ( Please confirm the completion of the following by ( x ) Mark
Yes No Yes No
Setting/Changing of SAFE Combination # Yes No General Cleanliness of ATM Yes No
Loading of Journal Printer Yes No Changing of Depository Print Head Yes No
Loading of Receipt Printer Yes No Clearing Jam in currency dispenser Yes No
Changing of Printer Ribbon Yes No Clearing of fitness errors Yes No
Cash Loading Procedure Yes No Transaction tested successfully Yes No
Bios Password Yes No C-Drive Only Bootable Device Yes No
Clearing jammed cards in card reader Yes No Hood&SAFE Keys handed over to custodian Yes No
Site Condition as per Specification :-
Earthing (Less than 1 V Yes No UPS output voltage
3 Phase VSAT / LL / Others
Electrical Points Other cabling
AC Installed
Acceptance Certificattion Yes No Consumable Details :-
Cash Balancing Yes No
Cash Loading Yes No Inkjet Cartridge
Pinging the switch Yes No
Balance Enquiry Yes No Receipt Roll
Pin Change Yes No
Fast Cash Yes No Journal Roll
Cash Withdrawal Yes No
Remarks :- ATM INSTALLED SUCCESSFULLY, PERFORM ONLINE TRANSACTION DONE.
Installation Date Warranty Expiry Date
For NCR Corporation India Pvt. Ltd. For Customer
NCR Services division
Signature Signature
Date Date
Name Name
CSR Code Emp. Code
Supporting Branch Designation
NCR Corporation India Pvt.Ltd., Godrej Business District, IT Park-2, Block-B, Pirojshanagar, LBS Marg, Vikhroli(W), Mumbai-400079, India
Registered Office :- #11, Palace Road, Niton Building 3rd Floor, Bangalore-560052
Distribution :- White-customer, Blue-GSM, Green-Services, Yellow-Regional Office
We hereby certify that the installation is completed to our satisfaction. Software loaded as as authorised by the bank, which are required for normal functioning of an ATM. There is no tamper found
in the ATM at the time of unpacking and installation. All the thirs party products mentioned carries the OEM standard warranty terms & condition given overleaf are noted
For Service contact :- NCR FSC-Field Support Centre Toll Free 1800 209 5657 / 1800 200 5657
