(Personalized Seal). Acknowledgment receipt examples.Use this sample as a guide to help you create your own acknowledgment receipt: Sample 1. The signer instead makes a mark (such as an "X") or other symbols on the document. Here's a guide to help you understand why you need an acknowledgement statement and how to make yours as effective as possible. You must use the filing application to generate the form and print it from there. A form for the employee to sign acknowledging receipt of the policies. Following are samples of these provisions. DOE acknowledges receipt of Concept Papers via email to the submission point of contact. If you are the business entity that is completing the form, you are a filer type CERT-BUS.