Depositor Copy Branch Copy

Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch Date: 26-07-2018 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: 26-07-2018
State Bank MOPS Reference No. CPI9578885
Benificiary/Remittance Details
Beneficiary: CSAB 2018
State Bank MOPS Reference No. CPI9578885
Merchant Reference No: 259008402018701
Beneficiary: CSAB 2018
Candidate Name: SURAJ KUMAR
Merchant Reference No: 259008402018701
JEE(Main) 2018 Roll No.: 25900840
Candidate Name: SURAJ KUMAR
Rs P
JEE(Main) 2018 Roll No.: 25900840
Collection Amount 16500 00
Comission 59 00 Rs P
Total ( Sixteen Thousand And Five Hundred And Fifty Nine Rupees Only) 16559 00 Collection Amount 16500 00
Comission 59 00
Details of Cash Rs p Total ( Sixteen Thousand And Five Hundred And Fifty Nine Rupees Only) 16559 00

Cash

Amount
Total Rs
Cash Notes Rs P

Instructions for Depositor: This is not an e-receipt. *2000

*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