(last date to remit the money 09/09/2011)

PAY-IN-SLIP BANKS COPY

KVPY 2011 INDIAN INSTITUTE OF SCIENCE BANGALORE 560 012

(last date to remit the money 09/09/2011)

PAY-IN-SLIP CANDIDATESS COPY
KVPY 2011 INDIAN INSTITUTE OF SCIENCE BANGALORE 560 012

(last date to remit the money 09/09/2011)

PAY-IN-SLIP TO BE ENCLOSED WITH THE APPLICATION
KVPY 2011 INDIAN INSTITUTE OF SCIENCE BANGALORE 560 012

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

SB A/C No. 10270577392

Rupees Application No.:

SB A/C No. 10270577392

Rupees

SB A/C No. 10270577392

Rs.
Rupees

Rs.

Rs.

Application No.:

Application No.:

. . Name and . address of the candidate . . Pin Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

. . Name and . address of the candidate . . Pin Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

Name and address of the candidate

. . . . . Pin

Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

*Girl/Physically/Visually challenged students are exempted from payment of processing fee.