PAYMENT CHALLAN FORM 01 (CASH VOUCHER)

PAYMENT CHALLAN FORM 01 (CASH VOUCHER)

BRANCH COPY
UTTARAKHAND GRAMIN BANK
Application Fee Details
Recruitment of Officer Scale-I
In Uttarakhand Gramin Bank

UTTARAKHAND GRAMIN BANK

Application Fee Details
Recruitment of Officer Scale-I
In Uttarakhand Gramin Bank
ACCOUNT NO. :

Uttarakhand Gramin Bank : 92197001016

ACCOUNT NO. :

Uttarakhand Gramin Bank: 92197001016

Place for
Candidates
New
Photograph

Dehradun

Dehradun
Candidates Name
Category *

CANDIDATES COPY

Candidates Name
Category *

: Mr./Mrs/Kum.............................................................

:
SC/ST/PWD
For all others

Rs. 20/Rs.100/-

: Mr./Mrs/Kum.............................................................

:
SC/ST/PWD

Rs. 20/-

For all Others

........................ ......... .......... ......

Rs.100/.............. .......... ......... ................

Date of Birth

Branch Name

Branch Code No. #

: .................................................

Journal No. #

: .................................................

Date of Deposit

: .................................................

Application Fee

: .................................................

Date of Birth
Branch Name

:
: .

Branch Code No. #

: .................................................

Journal No. #

: .................................................

Date of Deposit

: .................................................

Application Fee

: .................................................

(Rupees.
only)

(Rupees..............................................................................................................only)
Signature of Depositor
Address :...................................................................
..................................................................................
..................................................................................
Phone/ Mob. No. .....................................................

Authorised Signatory
Stamp

* Tick whichever is applicable.

# Fee receiving branch is advised to write the Journal No. and Branch Code No.
above invariably.

Signature of Depositor
Address :...................................................................
..................................................................................
..................................................................................
Phone/ Mob. No. .....................................................

Authorised Signatory
Stamp

* Tick whichever is applicable.

# Fee receiving branch is advised to write the Journal No. and Branch Code No.
above invariably.
[This part of the challan will be required to be submitted by the candidate at the time
of Interview otherwise the candidate will not be allowed to appear in interview]