E-Procurement Project

Govt. of Karnataka

Tender No : MI/2010-11/AB/WORK_INDENT1872

Axis Bank Branch : _____________________

Date of Deposit: _____________________(DD/MM/YYYY)

E-Procurement Payment Reference No: B101587/E/O/01

OTC Payment Challan

Desk officer please remember to input e-Procurement payment reference

number AND 16 digit OTC or Bank transaction reference no.in the
Transaction remarks column in Axis Bank's Core Banking System
(1st Copy to be retained by Axis Bank Collecting Branch)

Payment Type : EMD

Name of the Supplier/Contractor. M SHARANABASAPPA ( M SHARANABASAPPA )

Name of the Supplier/Contractor's Company. M SHARANABASAPPA

Supplier Registration Number. S15854

Supplier Address. CONTRACTOR, S/O LATE SRI M MALLAPPA EX MLA,

7th WARD, MALLIKARJUNA NILAYA, SINDHANUR,
RAICHUR DISTRICT, 584128.

Supplier Telephone No. 91-9900467999

___________________________
Mode of Transaction(Cash,DD).

Demand Draft to be made in favour of : e-Procurement,Government of Karnataka

DD shall be payable at the place where the DD is
deposited

Amount (Rs. in Figure) 50000.0

Amount (Rs. in Words) Fifty Thousand (dot) Zero Only.

Service Charges (Rs.22 for Cash, Rs 18 for DD) ________________________

Total Amount (Rs.) ________________________

Payment Details:
______________________________
DD No.
______________________________
Drawn on.
______________________________
DD Date.
______________________________
Depositor's Signature.
Received the above amount on ............................................
____________________________
SOL ID of Branch
_____________________________
Date of Deposit
_____________________________
Bank Transaction Reference Number
_____________________________
Sr. No
______________________________
Cashier's Signature
 E-Procurement Project
Govt. of Karnataka

Axis Bank Branch : _________________________

Date of Deposit: ________________________ (DD/MM/YYYY)

E-Procurement Payment Reference No: B101587/E/O/01

OTC Payment Challan

Desk officer please remember to input e-Procurement payment reference

number AND 16 digit OTC or Bank transaction reference no.in the
Transaction remarks column in Axis Bank's Core Banking System
(2nd Copy to be retained by the Contractor)

Payment Type : EMD

Name of the Supplier/Contractor. M SHARANABASAPPA ( M SHARANABASAPPA )

Name of the Supplier/Contractor's Company. M SHARANABASAPPA

Supplier Registration Number. S15854

Supplier Address. CONTRACTOR, S/O LATE SRI M MALLAPPA EX MLA,

7th WARD, MALLIKARJUNA NILAYA, SINDHANUR,
RAICHUR DISTRICT, 584128.

Supplier Telephone No. 91-9900467999

___________________________
Mode of Transaction(Cash,DD).

Demand Draft to be made in favour of : e-Procurement,Government of Karnataka

Amount (Rs. in Figure) 50000.0

Amount (Rs. in Words) Fifty Thousand (dot) Zero Only.

Service Charges (Rs.22 for Cash, Rs 18 for DD) __________________________

Total Amount (Rs.) __________________________

Payment Details:
______________________________
DD No.
______________________________
Drawn on.
______________________________
DD Date.
______________________________
Depositor's Signature.

Received the above amount on .............................................

_____________________________
SOL ID of Branch
_____________________________
Date of Deposit
_____________________________
Bank Transaction Reference Number
______________________________
Sr. No
______________________________
Cashier's Signature