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Sheet1

Applicant copy

BAJA SAEINDIA
“ N A T R A X
I N D O R E

N A T R i

P

AADTS3913K

The PAN NO. of BAJA SAEINDIA
Name of branch:
Date of Deposit:
D D/M M/Y Y
(to be treated by Party as fee receipt)
Account to be credited

0 0 3 6 S L F E E C O L

1. BAJA SAEINDIA CODE

:

F C B J S A

2.Student / College Name

:

3. Roll No./ Registration ID

:

4. Class/TEAM Name

:

5. Course/( Virtual/Main)

:

V I

6. Amount

:

16854

7. Amount in words

:

Rupees Sixteen Thousand Eight Hundred
Fifty Four Only

R T U A L

8. Cash Details:
Denomination

Amount

1000 X
500 X
100 X
50 X
20 X
10 X
5X
Coins
Total
Cheque / Payorder / DD No.

Drawn On Bank

Payable At Branch:
Signature/ Stamp
ICICI Bank Ltd

Signature of Depositor

* must be drawn payable at the centre of deposit of the instrument I.e. outstation instruments not acceptable

Page 1

Sheet1 * must be drawn payable at the centre of deposit of the instrument I. outstation instruments not acceptable Page 2 .e.

BAJA SAEINDIA CODE : 2. Cash Details: Denomination Amount 1000 X 500 X 100 X 50 X 20 X 10 X 5X Coins Total Cheque / Payorder / DD No. Amount : 16854 7. of BAJA SAEINDIA Name of branch: Date of Deposit: D D/M M/Y Y (to be treated by Party as fee receipt) Account to be credited 0 0 3 6 S L F E E C O L F C B J S A 1. outstation instruments not acceptable Page 3 . Amount in words : R T U A L Rupees Sixteen Thousand Eight Hundred Fifty Four Only 8. / Registration ID : 4. Roll No. Course/( Virtual/Main) : V I 6.Student / College Name : 3.Sheet1 BAJA SAEINDIA Copy BAJA SAEINDIA “ N A T R A X I N D O R E N A T R i P AADTS3913K The PAN NO. Class/TEAM Name : 5. Drawn On Bank Payable At Branch: Signature/ Stamp ICICI Bank Ltd Signature of Depositor * must be drawn payable at the centre of deposit of the instrument I.e.

Sheet1 * must be drawn payable at the centre of deposit of the instrument I. outstation instruments not acceptable Page 4 .e.

BAJA SAEINDIA CODE : F C B J S A 2. Course/( Virtual/Main) : V I 6. Cash Details: Denomination Amount 1000 X 500 X 100 X 50 X 20 X 10 X 5X Coins Total Cheque / Payorder / DD No. Roll No. outstation instruments not acceptable Page 5 . Amount in words : R T U A L Rupees Sixteen Thousand Eight Hundred Fifty Four Only 8. Drawn On Bank Payable At Branch: Signature/ Stamp ICICI Bank Ltd Signature of Depositor * must be drawn payable at the centre of deposit of the instrument I. of BAJA SAEINDIA Name of branch: Date of Deposit: D D/M M/Y Y (to be treated by Party as fee receipt) Account to be credited 0 0 3 6 S L F E E C O L 1. Class/TEAM Name : 5. / Registration ID : 4. Amount : 16854 7.e.Sheet1 Bank Copy BAJA SAEINDIA “ N A T R A X I N D O R E N A T R i P AADTS3913K The PAN NO.Student / College Name : 3.

Sheet1 * must be drawn payable at the centre of deposit of the instrument I. outstation instruments not acceptable Page 6 .e.