JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION & RESEARCH

JIPMER MBBS 2013

Applicant Copy

JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION & RESEARCH

JIPMER MBBS 2013
Bank Copy

Online Application No. Name Date of Birth & Gender Category Bank Branch Code Journal No ( For Bank Use Only )

165703 SUSHMITHA S R 12 Dec 1995 & Female UR

Online Application No. Name Date of Birth & Gender Category Bank Branch Code Journal No ( For Bank Use Only )

165703 SUSHMITHA S R 12 Dec 1995 & Female UR

Paid into the Credit of The Jawaharlal Institute Of Postgraduate Medical Education & Research

Paid into the Credit of The Jawaharlal Institute Of Postgraduate Medical Education & Research

CBS SCREEN NUMBER: 8888 FEE TYPE: 123

Particulars Fee Bank Charges Total Amount (Rs)

CBS SCREEN NUMBER: 8888 FEE TYPE: 123

Particulars Fee Bank Charges Total Amount (Rs)

1000
50

1000
50

1050

1050

Signature of the Applicant Received a sum of Rs. (in words )

Signature of the Applicant Received a sum of Rs. (in words )

Rupees One Thousand Fifty Only

Rupees One Thousand Fifty Only

Date and Seal

Signature of the receiving authority

Date and Seal

Signature of the receiving authority

Accepted at all Branches of State Bank of India The challan copy should be furnished at the time of verification.

Accepted at all Branches of State Bank of India The challan copy should be furnished at the time of verification.

Please pay the fee only after 24 hours of Generating this Challan.

Please pay fee only after 24 hours of Generating this Challan.