Convener (SSB) Copy Candidate Copy Bank Copy

Application Form for the post of HC Application Form for the post of HC Application Form for the post of HC
(MINISTERIAL) (MINISTERIAL) (MINISTERIAL)
Registration Registration Registration
10178834 10178834 10178834
Id: Id: Id:
Candidate Candidate Candidate
jaideep jaideep jaideep
Name: Name: Name:
DOB: 16-04-1999 DOB: 16-04-1999 DOB: 16-04-1999
Reference Reference Reference
22-Aug-2018 22-Aug-2018 22-Aug-2018
Date: Date: Date:
Mobile No: 7082312694 Mobile No: 7082312694 Mobile No: 7082312694
CBS SCREEN NUMBER: 8888 CBS SCREEN NUMBER: 8888 CBS SCREEN NUMBER: 8888
FEE TYPE: 241 FEE TYPE: 241 FEE TYPE: 241
Head Amount Credit To Head Amount Credit To Head Amount Credit To
Application Application Application
100 3755934400 100 3755934400 100 3755934400
Fee Fee Fee
Bank Charges 20 Bank Charges 20 Bank Charges 20
Total 120 Total 120 Total 120
Amount in Words :One Hundred and Amount in Words : One Hundred and Amount in Words : One Hundred and
Twenty rupees only Twenty rupees only Twenty rupees only

Signature of the Candidate Signature of the Candidate Signature of the Candidate

For Receiving Bank Use only For Receiving Bank Use only For Receiving Bank Use only
Journal Journal Journal
Branch Branch Branch
Number Number Number
Name Code Name Code Name Code

Authorized Signatory Authorized Signatory Authorized Signatory

SEAL : SEAL : SEAL :
DATE : DATE : DATE :
Note: Note: Note:
Challan can be submitted any SBI Challan can be submitted any SBI Challan can be submitted any SBI
Branch. Branch. Branch.
Challan copy furnished at the time of Challan copy furnished at the time of Challan copy furnished at the time of
verification. verification. verification.
Bank may please accept this challan on or Bank may please accept this challan on or Bank may please accept this challan on or
before 09-SEPTEMBER-2018. before 09-SEPTEMBER-2018. before 09-SEPTEMBER-2018.