(last date to remit the money 09/09/2011)

PAY-IN-SLIP BANKS COPY

KVPY 2011 INDIAN INSTITUTE OF SCIENCE BANGALORE 560 012

(last date to remit the money 09/09/2011)

PAY-IN-SLIP CANDIDATESS COPY

(last date to remit the money 09/09/2011)

PAY-IN-SLIP TO BE ENCLOSED WITH THE APPLICATION

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

State Bank of India

Payable at all Branches of SBI in India Branch Name and Address: Paid into the credit of Kishore Vaigyanik Protsahan Yojana(KVPY)

SB A/C No. 10270577392

Rupees Application No.:

SB A/C No. 10270577392

Rs. Rs.
Rupees

SB A/C No. 10270577392

Rupees

Application No.:

Application No.:

. Name and . address of . the candidate . . Pin Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

. Name and . address of . the candidate . . Pin Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

Name and address of the candidate

. . . . . Pin

Application Processing fee: Tick as applicable General Category SC/ST (a) Rs. 200/- (a) Rs. 100/- (b) Bank charges if (b) Bank charges if any any
Signature of the Depositor Signature of the Cashier Bank Stamp with date

*Girl/Physically/Visually challenged students are exempted from payment of processing fee.