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(ENCLOSURE III

)
STUDENT’S COPY

SCDL COPY

BANK’S COPY

SYMBIOSIS

SYMBIOSIS

SYMBIOSIS

CENTRE FOR DISTANCE LEARNING

CENTRE FOR DISTANCE LEARNING

CENTRE FOR DISTANCE LEARNING

EXAM FEE CHALLAN
JAN / FEB 2007

EXAM FEE CHALLAN
JAN / FEB 2007

EXAM FEE CHALLAN
JAN / FEB 2007

Challan No.:

Challan No.:

Challan No.:

A/c Code : SYMBDL
Branch Name :________________
(To be treated by the student as Exam Fee Receipt)

A/c Code : SYMBDL

Date of Receipt

Date of Receipt

:

_____/____/2006

University / School :

SCDL

Branch Name :________________

:

_____/____/2006

University / School :

SCDL

A/c Code : SYMBDL
Date of Receipt

Branch Name :________________

:

_____/____/2006

University / School :

SCDL

Student Name :

____________________________________

Student Name :

____________________________________

Student Name :

____________________________________

Roll No./Reg.No.:

____________________________________

Roll No./Reg.No.:

____________________________________

Roll No./Reg.No.:

____________________________________

Student Tel/Cell. No.: ____________________________________

Student Tel/Cell. No.: ____________________________________

Student Tel/Cell. No.: ____________________________________

Email

Email

Email

:

____________________________________

:

____________________________________

:

____________________________________

Batch Year /Course : ____________________________________

Batch Year /Course : ____________________________________

Batch Year /Course : ____________________________________

Exam Centre & City : ____________________________________

Exam Centre & City : ____________________________________

Exam Centre & City : ____________________________________

Type of Fee : Exam Fee
(Please furnish details of the subjects overleaf)

Type of Fee : Exam Fee
(Please furnish details of the subjects overleaf)

Type of Fee : Exam Fee
(Please furnish details of the subjects overleaf)

No. of Subjects appearing for : ________X 125 per subject

No. of Subjects appearing for : ________X 125 per subject

No. of Subjects appearing for : ________X 125 per subject

Total Exam Fees : ______________________________________

Total Exam Fees : ______________________________________

Total Exam Fees : ______________________________________

Total Fee Amount : ______________________________________

Total Fee Amount : ______________________________________

Total Fee Amount : ______________________________________

Amount in words : ______________________________________

Amount in words : ______________________________________

Amount in words : ______________________________________

Mode of Payment :

Mode of Payment :

Mode of Payment :

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Ps.Please indicate the subject codes for which you have remitted the Exam Fee – Please indicate the subject codes for which you have remitted the Exam Fee – Please indicate the subject codes for which you have remitted the Exam Fee – 1_________________ 10_________________ 1_________________ 10_________________ 1_________________ 10_________________ 2_________________ 11_________________ 2_________________ 11_________________ 2_________________ 11_________________ 3_________________ 12_________________ 3_________________ 12_________________ 3_________________ 12_________________ 4_________________ 13_________________ 4_________________ 13_________________ 4_________________ 13_________________ 5_________________ 14_________________ 5_________________ 14_________________ 5_________________ 14_________________ 6_________________ 15_________________ 6_________________ 15_________________ 6_________________ 15_________________ 7_________________ 16_________________ 7_________________ 16_________________ 7_________________ 16_________________ 8_________________ 17_________________ 8_________________ 17_________________ 8_________________ 17_________________ 9_________________ 18_________________ 9_________________ 18_________________ 9_________________ 18_________________ Other Remarks :________________________ _____________________________________ _____________________________________ _____________________________________ Other Remarks :________________________ _____________________________________ _____________________________________ _____________________________________ Other Remarks :________________________ _____________________________________ _____________________________________ _____________________________________ Particulars of Cash Deposited :Cash Deposit DENO PIECES 1000 X Particulars of Cash Deposited :Cash Deposit DENO PIECES 1000 X Particulars of Cash Deposited :Cash Deposit DENO PIECES 1000 X Rs. Ps. Rs. . Ps. 500 X 500 X 500 X 100 X 100 X 100 X 50 X 50 X 50 X 20 X 20 X 20 X 10 X 10 X 10 X 5 X 5 X 5 X COINS COINS COINS TOTAL TOTAL TOTAL Rs.