Applicants Name*: (To be filled in capital letters) Applicants Name*: (To be filled in capital letters) Applicants Name*: (To

be filled in capital letters)

_____________________________________________ __________________________________________ _____________________________________________
(Surname) (Name) (Middle Name) (Surname) (Name) (Middle Name) (Surname) (Name) (Middle Name)
Mobile No: Mobile No: Mobile No:
Fees
(in Rs)
Fees
(in Rs)
Fees
(in Rs)
MSEDCL FEE CHALLAN FOR APPLICATION TO THE SENIOR
POSTS VIDE ADVT.10/2012 [Post Code - ]
Bank of Maharashtra
Candidate applying against the category
-.....| .. ...| .....-.. . .. +...... .- ..
( ) -.| .. +..|
Branch Name:
Bank of Maharashtra'- Account No. 20045003931
MSEDCL FEE CHALLAN FOR APPLICATION TO THE
SENIOR POSTS VIDE ADVT.10/2012 [Post Code - ]
Bank of Maharashtra
Candidate applying against the category
-.....| .. ...| .....-.. . .. +...... .-
( ) -.| .. +..|
Bank of Maharashtra'- Account No. 20045003931
Amount may be deposited in any branch of
Branch Name:
MSEDCL FEE CHALLAN FOR APPLICATION TO THE
SENIOR POSTS VIDE ADVT.10/2012 [Post Code - ]
Bank of Maharashtra
Amount may be deposited in any branch of
Bank of Maharashtra'- Account No. 20045003931
Branch Name:
Amount may be deposited in any branch of
Candidate applying against the category
-.....| .. ...| .....-.. . .. +...... .-
( ) -.| .. +..|

SC SC SC
ST ST ST
VJ(A) } coming VJ(A) } coming VJ(A) } coming
NT-B } under the NT-B } under the NT-B } under the
NT-C } concept of NT-C } concept of NT-C } concept of
NT-D } Non-creamy NT-D } Non-creamy NT-D } Non-creamy
SBC } Layer SBC } Layer SBC } Layer
OBC } OBC } OBC }
OPEN OPEN OPEN
Persons with Disability & Ex-Serviceman: Not Applicable Persons with Disability & Ex-Serviceman: Not Applicable Persons with Disability & Ex-Serviceman: Not Applicable
Total Total Total
In Words (Rupees ) In Words (Rupees ) In Words (Rupees )
Date: Signature of Candidate Date: Signature of Candidate Date: Signature of Candidate
Transaction ID/ Journal No. ______________________ Transaction ID/ Journal No. __________________ Transaction ID/ Journal No. ________________
Branch Name : _________________________________ Branch Name : ____________________________ Branch Name : ___________________________
( ) -.| .. +..| ( ) -.| .. +..|
[To be filled in by the Bank Branch Office]
Last Date of Acceptance of Deposit: 15.12.2012 Last Date of Acceptance of Deposit: 15.12.2012
[To be filled in by the Bank Branch Office]
Last Date of Acceptance of Deposit: 15.12.2012
[To be filled in by the Bank Branch Office]
TO BE ACCEPTED THROUGH MSEDCL FEE MODULE ONLY TO BE ACCEPTED THROUGH MSEDCL FEE MODULE ONLY TO BE ACCEPTED THROUGH MSEDCL FEE MODULE ONLY
( ) -.| .. +..|
Branch Name : _________________________________ Branch Name : ____________________________ Branch Name : ___________________________
Branch Code: __________________________________ Branch Code: _____________________________ Branch Code: ____________________________
Date of Receipt of Fee: _________________________ Date of Receipt of Fee: ____________________ Date of Receipt of Fee: ___________________
Signature of Bank Official & Seal Signature of Bank Official & Seal Signature of Bank Official & Seal

[Bankers Copy] [CANDIDATE COPY] [MSEDCL Copy - TO BE ATTACHED ALONG WITH APPLICATION]