DECCAN GRAMEENA BANK :: HEAD OFFICE :: NALLAKUNTA, HYDERABAD: PHONE.NO.

040-27600849 RECRUITMENT PROJECT CWE-IBPS-2012 Officer MM-III, MM-II, Officer JM-I & Office Assistant (Multipurpose) APPLICATION FEE PAYMENT CHALLAN (Branch copy) To be filled in by the CANDIDATE Applicants Name ( In Block Letters) (Please note: Applicants Name in this challan and on the On-Line application should be the same) Officer Officer Officer Office Post applied for MMGS-III MMGS-II JMGS-I Assistant (Tick whichever is applicable) Application fee for Officers SC Category Application fee for Office Asssiatnts SC Category FOR BRANCH USE 79010096294 WITH DGB NALLAKUNTA, HYDERABAD ST Rs.20/Rs.100/Tick[] whichever is applicable Rs.20/ST PWD Rs.100/All other

DECCAN GRAMEENA BANK :: HEAD OFFICE :: NALLAKUNTA, HYDERABAD: PHONE.NO.040-27600849 RECRUITMENT PROJECT CWE-IBPS-2012 Officer MM-III, MM-II, Officer JM-I & Office Assistant (Multipurpose) APPLICATION FEE PAYMENT CHALLAN (Applicant's copy) To be filled in by the CANDIDATE Applicants Name ( In Block Letters) (Please note: Applicants Name in this challan and on the On-Line application should be the same) Officer Officer Officer Office Post applied for MMGS-III MMGS-II JMGS-I Assistant (Tick whichever is applicable) Application fee for Officers SC Category Application fee for Office Asssiatnts SC Category FOR BRANCH USE 79010096294 WITH DGB NALLAKUNTA, HYDERABAD ST Rs.20/PWD Rs.100/EX-SER All other Tick[] whichever is applicable Rs.20/ST PWD Rs.100/All other

PWD EX-SER All other

Account Number Branch Code & Name Date of payment

Account Number Branch Code & Name

From 19-12-2012 to Date of payment 01-01-2013 only Transaction Id/Journal No./Queue No.

From 19-12-2012 to 01-01-2013 only

Transaction Id/Journal No./Queue No.

Authorised Signatory with Signature No & Br.Seal

Applicants/Remitters Signature

Date

Authorised Signatory with Signature No & Br.Seal

Applicants/Remitters Signature

Date