Branch Copy

ESIC Copy

Remitters Copy

Employees State Insurance Corporation

Employees State Insurance Corporation

Employees State Insurance Corporation

Indian Bank
Reference No. : MU00281050 Recruitment for post of Paramedical Staff, Chennai. CBS CHALLAN FORM
IB Branch Detail in which fees deposited Branch Name & Code Candidate application No.: Name of the Candidate Fathers/ Husbands Name Date of Birth Category Name of the Bank where fee is to be credited Branch Name & Code City Name of the Account Journal No issued by the bank Deposit Date Amount credited Bank Transaction Charges Total Amount Signature of the Depositor Address `. 225/`.20/`. 245/-

Indian Bank
Reference No. : MU00281050 Recruitment for post of Paramedical Staff, Chennai. CBS CHALLAN FORM
IB Branch Detail in which fees deposited Branch Name & Code

Indian Bank
Reference No. : MU00281050 Recruitment for post of Paramedical Staff, Chennai. CBS CHALLAN FORM
IB Branch Detail in which fees deposited Branch Name & Code

103553 AJIN S B SAIRAS I 1/5/1989 OBC

Candidate application No.: Name of the Candidate Fathers/ Husbands Name Date of Birth Category Name of the Bank where fee is to be credited Branch Name & Code City Name of the Account Journal No issued by the bank Deposit Date Amount credited Bank Transaction Charges Total Amount Signature of the Depositor Address

103553 AJIN S B SAIRAS I 1/5/1989 OBC

Candidate application No.: Name of the Candidate Fathers/ Husbands Name Date of Birth Category Name of the Bank where fee is to be credited Branch Name & Code City Name of the Account Journal No issued by the bank Deposit Date

103553 AJIN S B SAIRAS I 1/5/1989 OBC

INDIAN BANK
Sterling Road, 00565 Chennai

INDIAN BANK
Sterling Road, 00565 Chennai

INDIAN BANK
Sterling Road, 00565 Chennai

ESICH Saving Fund-Fee collection

ESICH Saving Fund-Fee collection

ESICH Saving Fund-Fee collection

`. 225/`.20/`. 245/-

Amount credited Bank Transaction Charges Total Amount Signature of the Depositor Address

`. 225/`.20/`. 245/-

Authorised Signatory Stamp Phone No: Phone No:

Authorised Signatory Stamp Phone No:

Authorised Signatory Stamp