CHALLAN FORM (CASH VOUCHER) CHALLAN FORM (CASH VOUCHER)

BRANCH COPY CANDIDATE’S COPY

HARYANA GRAMIN BANK - 01 HARYANA GRAMIN BANK - 01
Application Fee Details Application Fee Details Affix Pass port
Recruitment of Officer Junior Management (Scale-I) Recruitment of Officer Junior Management (Scale-I) size Photograph
in Haryana Gramin Bank in Haryana Gramin Bank
Account No : 80561700097843-HGBRECTPRJT2011
at HGB, Rohtak Branch (code - 8056) Account No : 80561700097843-HGBRECTPRJT2011
Institute ID : HGBRO at HGB, Rohtak Branch (code - 8056)
Candidate’s Name : Mr./Mrs/Kum. ……………………….. Institute ID : HGBRO
Candidate’s Name : Mr./Mrs/Kum………………………………..
Category* : SC/ST/PWD Rs.50/- (Only Postage)
OBC/GEN/EXS Rs.500/- (Application
Category* SC/ST/PWD Rs.50/- (Only Postage)
fee & Postage) OBC/GEN/EXS Rs.500/- (Application
Date of fee & Postage)
Birth :
Date of Birth :
HGB Branch Name :
HGB Branch Name:
Branch Code No# :
Branch Code No# :
Transaction ID # :
Transaction ID # :
Deposit Date :
Deposit Date :
Application Fee/Postage Rs. .......................
Amount Rs. .......................
(Rupees..........................................................................................only)
(Rupees..........................................................................................only)

Signature of Depositor Authorized Signatory

Address:.................... Stamp Signature of Depositor Authorized Signatory
................................... Address:.................... Stamp
Phone/Mob. No. (Make entry in Tran. Particular Column of payee) ...................................
Phone/Mob. No.
* Tick whichever is applicable. * Tick whichever is applicable.
# Fee receiving branch is advised to write the Transaction ID and # Fee receiving branch is advised to write the Transaction ID and Branch
Branch Code No. above invariably. Code No. above invariably.
(This part of the challan will be required to be submitted by the candidate at the time of
written test along with a photograph, otherwise the candidate will not be allowed to appear
at the examination.)