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Depositor Copy Branch Copy

Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch Date: 30-09-2016 Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch

Benificiary/Remittance Details Branch Teller: Use SCR 008765 Deposit > Fee Collection > State Bank Collect
Date: 30-09-2016
State Bank MOPS Reference No. CP59763585
Benificiary/Remittance Details
Beneficiary: GATE 2017 IIT ROORKEE
State Bank MOPS Reference No. CP59763585
Merchant Reference No: 21053980
Beneficiary: GATE 2017 IIT ROORKEE
Candidate Name: SUNIL PATANWADIYA
Merchant Reference No: 21053980
Registration ID: R326E28
Candidate Name: SUNIL PATANWADIYA
Rs P
Registration ID: R326E28
Collection Amount 1500 00
Comission 58 00 Rs P
Total ( One Thousand And Five Hundred And Fifty Eight Rupees Only) 1558 00 Collection Amount 1500 00
Comission 58 00
Details of Cash Rs p Total ( One Thousand And Five Hundred And Fifty Eight Rupees Only) 1558 00

Cash

Amount
Total Rs
Cash Notes Rs P

Instructions for Depositor: This is not an e-receipt. *1000


*500
(To be Filled in by the Bank) *100
*50
Journal No:
*20
*10
Branch Name:
Coins
Branch Code: Deposit Date:
Total Rs

Branch Stamp

Signature of the Depositor


Authorised Signatory

Space for Bank use


Branch Stamp