Application For CLASSROOM STUDENTS FEE RECEIPT

"SANKALP" CP-6, Indra Vihar, Kota-324005 (0744) 2436001 MAJOR TEST SERIES [Session 2012-2013] "SANKALP" CP-6, Indra Vihar, Kota-324005 (0744) 2436001
“SAMANVAYA”, C-210/2, Talwandi, Kota-324005 Ph. : (0744) 2405004
(Session 2012-2013)
“SAMANVAYA”, C-210/2, Talwandi, Kota-324005 Ph. : (0744) 2405004

Sir, Due to personal circumstances I can't appear in Major Test Series of Regular Class MAJOR TEST SERIES For
Room Programme, hence kindly permit me to appear in Major Test Series at CLASSROOM STUDENTS [Session 2012-13]
*Applicable for sit-down

1
(Name of Test Centre*) ________________ Test Series only
Form No. :
I am enclosing my I-Card : Yes / No Form No. :

1
(Please fill all the details in Capital Letters only) Student’s Name
Student’s Name

Batch/Reg. No. Parent's/Guardian's Name

Parent's/Guardian's Name
Fee Structure (SERVICE TAX REG. NO. : AAEFA3972BST001)

Address Course Tution Course Fee Service Tax Total Fee

Fee Advance (12.36%)
IIT-JEE ` 500 -- ` 62 ` 562
PRE-MEDICAL ` 500 ` 300 ` 99 ` 899
AIEEE ` 500 - ` 62 ` 562

Pin : Tel. No. (if any) with STD Code

Details of Demand Draft/PayOrder
Fee Structure Demand Draft / Pay Order No. :
(SERVICE TAX REG.NO.: AAEFA3972BST001)
IMPORTANT INSTRUCTIONS (Subject to realisation)
Course Tution
Fee
Course Fee
Advance
Service Tax
(12.36%)
Total Fee
bl Challan dks iw.kZ :i ls Hkjdj dqy jkf'k
ds Bank Name :
IIT-JEE ` 500 -- ` 62 ` 562 Hkqxrku ds fy,
ATM CARD dksSWIPE djsa vFkok

PRE-MEDICAL ` 500 ` 300 ` 99 ` 899 fMek.M Mªk¶V@is&vkWMZj "ALLEN CAREER Dated :

AIEEE ` 500 -- ` 62 ` 562 INSTITUTE, KOTA" ds uke cuokdj Front Amount ( ` ) :

Office esa tek djk;saA (In Figures)
Details of Demand Draft/PayOrder
Amount ( ` ) :
Demand Draft / Pay Order No. : Dated : (In Words)

TEST CENTRE :
Bank Name :

Amount ( ` ) : Amount ( ` ) : ( Test Centre ij igys fnu bl Receipt dks lkFk ysdj vkosA)
(In Figures) (In Words)

Received A Demand Draft/Pay Order as per above details.

For office use only
Before filling this challan
For Office Use Only
please refer to Major Test
Series Booklet.

Depositor’s Signature & Date

For Accounts
Use Only Advice No. - Serial No. : Thanks 