Welcome to Life Insurance Corporation of India - Application Form Print

Page 1 of 1

Candidate's Copy STATE BANK OF INDIA Application Fee Challan LIFE INSURANCE CORPORATION OF INDIA RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICERS - 2013 Candidate Details Name Registration No Date of Birth Category Centre Name Mobile No. : Rohit Bhardwaj : 1993393 : 02-09-1987 : GENERAL : DELHI : 9878513948 Date of Deposit : ....... / ....... / 2013 Branch Code Journal No.

Fee Payment will be accepted from 2nd working day after Registration.

Amount (in figures) Amount (in words) Forty Rupees Only

: 540.00 : Five Hundred and

Branch Seal (within the Box only)

(Includes bank transaction charges for non exempt categories)

(Signature of the Candidate) (Authorised Signatory) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Bank's Copy STATE BANK OF INDIA Application Fee Challan LIFE INSURANCE CORPORATION OF INDIA RECRUITMENT OF ASSISTANT ADMINISTRATIVE OFFICERS - 2013 Instruction for Branch Please go to Screen No. 8888 & Enter the following: Fee Collection Type Registration No Date of Birth Account No :0 0 0 1 1 7 : 1993393 : 02-09-1987 : 32830728812 Date of Deposit : ....... / ....... / 2013 Journal No Branch Code

Fee Payment will be accepted from 2nd working day after Registration. :

Amount (in figures) Amount (in words) Rupees Only

: 540.00 : Five Hundred and Forty Branch Seal (within the Box only)

(Includes bank transaction charges for non exempt categories)

(Signature of the Candidate) Name of the Candidate Mobile No. : Rohit Bhardwaj : 9878513948 (Authorised Signatory)

http://ibpsreg.sifyitest.com/licaao_feb13/challan1.php?regno=MTk5MzM5Mw==&pr... 28/03/2013