CHALLAN FORM (CASH VOUCHER) CHALLAN FORM (CASH VOUCHER)

BRANCH COPY CANDIDATE’S COPY

STATE BANK OF INDIA STATE BANK OF INDIA
Application Fee Details Application Fee Details
Recruitment of Office Assistant (Group ‘B’) Recruitment of Office Assistant(Group ‘B’)
in Uttaranchal Gramin Bank in Uttaranchal Gramin Bank
Affix Passport
Account No : 31580679985 Account No : 31580679985 Size Photograph
Candidate’s Name : Candidate’s Name :
(Mr./Mrs/Kum.) …………………………………………………………. (Mr./Mrs/Kum.)
………………………………………………………
Category* SC/ST/PC/EXS- Rs 75/-
OBC/GEN - Rs. 325/- Category* SC/ST/PC/EXS- Rs 75/-
OBC/GEN - Rs. 325/-
Date of Birth :_______/__________/_________
Date of Birth :_______/__________/_________
SBI Branch Name :
SBI Branch Name :
Branch Code No# :
Branch Code No# :
Journal No # :
(7 to 10 digits) Journal No # :
(7 to 10 digits)
Deposit Date :
Deposit Date :
Amount Rs..........................................................................................
Amount Rs..........................................................................................
(Rupees..........................................................................................only)
(Rupees..........................................................................................only)

Signature of Depositor Authorized Signatory Signature of Depositor Authorized Signatory

Address:.................................. Stamp Address:........................................... Stamp

................................................. ...........................................................
Phone/Mobi. No. Phone/Mobi. No.
* Tick whichever is applicable. * Tick whichever is applicable.
# Fee receiving branch is advised to write the Deposit Journal No. and # Fee receiving branch is advised to write the Deposit Journal No. and
branch code no. above invariably. branch code no. above invariably.