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CANDIDATESS COPY

KVPY 2009
INDIAN INSTITUTE OF SCIENCE
BANGALORE 560 012

TO BE ENCLOSED WITH THE

APPLICATION

PAY-IN-SLIP

KVPY 2009
INDIAN INSTITUTE OF SCIENCE
BANGALORE 560 012

KVPY 2009
INDIAN INSTITUTE OF SCIENCE
BANGALORE 560 012

State Bank of India

State Bank of India

State Bank of India

Payable at all Branches of SBI in India

Payable at all Branches of SBI in India

Payable at all Branches of SBI in India

Branch Name and Address:

Branch Name and Address:

Branch Name and Address:

Paid into the credit of Administrative Executive,

KVPY, IISc., Bangalore 560 012

Paid into the credit of Administrative Executive,

KVPY, IISc., Bangalore 560 012

Paid into the credit of Administrative Executive,

KVPY, IISc., Bangalore 560 012

SB A/C No. 10270577392

SB A/C No. 10270577392

SB A/C No. 10270577392

Rupees

Rs.

Rupees

Rs.

Rupees

Rs.

Application No.

Application No.

Application No.

.
.
Name and
.
address of
the candidate .
.
Pin

.
.
Name and
.
address of
the candidate .
.
Pin

Application Processing fee:

Tick as applicable
(last date to remit the money 10/09/09)
General Category
SC/ST Category
(a) Rs. 200/-
(a) Rs. 100/-
(b) Bank charges if
(b) Bank charges if
any
any

Application Processing fee:

Tick as applicable
(last date to remit the money 10/09/09)
General Category
SC/ST Category
(a) Rs. 200/-
(a) Rs. 100/-
(b) Bank charges if
(b) Bank charges if
any
any

Application Processing fee:

Tick as applicable
(last date to remit the money 10/09/09)
General Category
SC/ST Category
(a) Rs. 200/-
(a) Rs. 100/-
(b) (b) Bank charges (b) (b) Bank charges
if any
if any

Signature of the
Depositor

Signature of the
Depositor

Signature of the
Depositor

Signature of the
Cashier

Signature of the
Cashier

Signature of the
Cashier

Bank Stamp with

date

Bank Stamp with

date

Bank Stamp with

date

Name and
address of
the candidate

.
.
.
.
.
Pin