District Recruitment Bureau TIRUCHIRAPPALLI District Recruitment Bureau TIRUCHIRAPPALLI

Pay in Slip for fee remittance Pay in Slip for fee remittance
Banker's copy Candidate's copy
Tiruchirappalli Dist.Central Cooperative Bank Ltd Tiruchirappalli Dist.Central Cooperative Bank Ltd
Payable at all branches of Tiruchirappalli Dist.Central Cooperative Bank Ltd Payable at all branches of Tiruchirappalli Dist.Central Cooperative Bank Ltd

Account Number 714858414 Account Number 714858414

HO/Branch HO/Branch

IFSC Code TNSC0011400 IFSC Code TNSC0011400

DRB Advertisement DRB Advertisement
Number Number

Name of the Candidate: Name of the Candidate:

Father's Name: Father's Name:

Date of Birth: Date of Birth:

Mobile No: Mobile No:

E-mail Id: E-mail Id:

Fee: Rs.250.00(Rupees Two Hundred and fifty only) By Fee: Rs.250.00(Rupees Two Hundred and fifty only) By
Cash Cash

Date: Signature of the Remitter Date: Signature of the Remitter

For Bank use Only For Bank use Only

Journal Id no: Journal Id no:

Branch Code: Branch Code:

Signature of Cashier: Signature of Cashier:

Signature of Authorised Signature of Authorised

Officer: Officer:

Date: Date:

Bank Seal Bank Seal