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Fee Payment Challan Copy 1 of 3 Fee Payment Challan Copy 2 of 3 Fee Payment Challan Copy 3 of 3

APPLICATION FEE / POSTAL CHARGES PAYMENT CHALLAN APPLICATION FEE / POSTAL CHARGES PAYMENT CHALLAN APPLICATION FEE / POSTAL CHARGES PAYMENT CHALLAN
BRANCH COPY APPLICANT'S COPY COPY TO BE SENT WITH THE APPLICATION

Recruitment Project – 2010 – Specialist/Generalist Officers – FROM Recruitment Project – 2010 – Specialist/Generalist Officers – FROM Recruitment Project – 2010 – Specialist/Generalist Officers –
MMG-S-II TO SMG-IV MMG-S-II TO SMG-IV FROM MMG-S-II TO SMG-IV
TO BE FILLED-IN BY THE CANDIDATE IN BLOCK LETTERS TO BE FILLED-IN BY THE CANDIDATE IN BLOCK LETTERS TO BE FILLED-IN BY THE CANDIDATE IN BLOCK LETTERS
Applicant’s Name: Applicant’s Name: Applicant’s Name:
Sri / Smt / Kum Sri / Smt / Kum Sri / Smt / Kum
Date of Birth Date of Birth Date of Birth
[DD-MM-YYYY] [DD-MM-YYYY] [DD-MM-YYYY]
Contact Phone/ Mobile No. Contact Phone/ Mobile No. Contact Phone/ Mobile No.
Email ID: Email ID: Email ID:
Amount in Rupees ` 50/- ` 300/- Amount in Rupees ` 50/- ` 300/- Amount in Rupees ` 50/- ` 300/-
Category* (Tick appropriate SC ST PWD All **Others Category* (Tick appropriate SC ST PWD All **Others Category* (Tick appropriate SC ST PWD All **Others
box) box) box)
Post Applied for Post Applied for Post Applied for
Post Code Post Code Post Code
` _______/- ` _______/- ` _______/-
Amount deposited [Rupees Amount deposited [Rupees Amount deposited [Rupees
________________________only] ________________________only] ________________________only]

Depositing Branch Name Depositing Branch Name Depositing Branch Name


Depositing Branch
Depositing Branch City/Location Depositing Branch City/Location City/Location
VIJAYA BANK REC-PROJ-2010-MMG-II VIJAYA BANK REC-PROJ-2010-MMG- VIJAYA BANK REC-PROJ-2010-MMG-
Name of the Account Name of the Account Name of the Account
– SMGIV II – SMGIV II – SMGIV
Account Number 900900022503003 Account Number 900900022503003 Account Number 900900022503003
Date of Payment ____ / ____ / 2010 Date of Payment ____ / ____ / 2010 Date of Payment ____ / ____ / 2010
Date of Payment [Only From 20.09.2010 to 15.10.2010 only] Date of Payment [Only From 20.09.2010 to 15.10.2010 only] Date of Payment [Only From 20.09.2010 to 15.10.2010 only]
Signature of Candidate / Signature of Candidate / Signature of Candidate /
Depositor: Depositor: Depositor:
Name of the Candidate/ Name of the Candidate/ Name of the Candidate/
Depositor: Depositor: Depositor:
Address: Address: Address:

TO BE FILLED-IN BY THE BRANCH OFFICIALS TO BE FILLED-IN BY THE BRANCH OFFICIALS TO BE FILLED-IN BY THE BRANCH OFFICIALS
Branch Code (Max. 5 digits) , Branch
Branch Code: Branch Code (Max. 5 digits) , Branch
Branch Code: Branch Code (Max. 5 digits) , Branch
Branch Code:
Name & Location of the Name:________________________ Name & Location of the Name:________________________ Name & Location of the Name:________________________
receiving Branch where Fees / receiving Branch where Fees / receiving Branch where Fees
Postage Charges Paid Postage Charges Paid / Postage Charges Paid
Transaction ID. Transaction ID. Transaction ID.
Authorised Signatory: Authorised Signatory: Authorised Signatory:
Branch Seal:__________ Branch Seal: Branch Seal:

* Tick whichever is applicable. ** All others include GEN/OBC/Ex- * Tick whichever is applicable. ** All others include GEN/OBC/Ex- * Tick whichever is applicable. ** All others include GEN/OBC/Ex-
Serviceman candidates. Note: Fee receiving branch is advised to write Serviceman candidates. Note: Fee receiving branch is advised to write Serviceman candidates. Note: Fee receiving branch is advised to write
Transaction ID & Branch Code No. above invariably Transaction ID & Branch Code No. above invariably Transaction ID & Branch Code No. above invariably