Name: Date: Description of Equipment or Property Issued to Employee: By signing this form, I agree to the following: I am responsible for the equipment or. This document is a receipt acknowledging payment received from an individual or entity.A form for the employee to sign acknowledging receipt of the policies. Following are samples of these provisions. Next, determine which form you will need, fill in the caption exactly as it appears on Notice to Defend and Divorce. Affidavit of Service (Certified Mail Restricted Delivery-Receipt Requested). Apply to any SUNY college or university through one easy form. Sign and date Form A4 and file it with your employer. Government 401(a) Retirement Plan.