Application No. .........................

Application No. .........................

Application No. .........................

BRANCH COPY

AZIM PREMJI UNIVERSITY COPY

APPLICANTS COPY

APPLICATION FEE PAYMENT CHALLAN

APPLICATION FEE PAYMENT CHALLAN

STATE BANK OF INDIA

APPLICATION FEE PAYMENT CHALLAN

STATE BANK OF INDIA

Admission to Post Graduate Programmes

Azim Premji University

STATE BANK OF INDIA

Admission to Post Graduate Programmes

Azim Premji University

Date:

Admission to Post Graduate Programmes

Azim Premji University

Date:

Date:

Account No: 31645699196 Azim Premji University - Fee A/c at

Specialized Mid Corporate branch, Kumara Park, Bangalore 560020,
Branch Code No.:14125

Account No: 31645699196 Azim Premji University - Fee A/c at

Specialized Mid Corporate branch, Kumara Park, Bangalore 560020,
Branch Code No.:14125

Account No: 31645699196 Azim Premji University - Fee A/c at

Specialized Mid Corporate branch, Kumara Park, Bangalore 560020,
Branch Code No.:14125

Name of the Applicant :_____________________________________________

Name of the Applicant :_____________________________________________

Name of the Applicant :_____________________________________________

Address :

Address :

Address :

Fee Required Rs.250/- (plus Bank Charges of Rs.25/- extra)

Fee Required Rs.250/- (plus Bank Charges of Rs.25/- extra)

Fee Required Rs.250/- (plus Bank Charges of Rs.25/- extra)

Signature of the Applicant :

Signature of the Applicant :

Signature of the Applicant :

(To be filled by the bank)

(To be filled by the bank)

Branch Stamp

SBI Branch Name :___________________________________

Branch Code

Deposit Date

SBI Branch Name :___________________________________

Branch Code

Journal No.

(To be filled by the bank)

Branch Stamp

Deposit Date

#Last date for Application fee receipt is Feb 10th 2012

SBI Branch Name :___________________________________

Branch Code

Journal No.

Authorised Signatory

Branch Stamp

Deposit Date

Journal No.

Authorised Signatory

#Last date for Application fee receipt is Feb 10th 2012

Authorised Signatory

#Last date for Application fee receipt is Feb 10th 2012

Application No. .........................

Application No. .........................

Application No. .........................

BRANCH COPY

AZIM PREMJI UNIVERSITY COPY

APPLICANTS COPY

APPLICATION FEE PAYMENT CHALLAN

APPLICATION FEE PAYMENT CHALLAN

APPLICATION FEE PAYMENT CHALLAN

Union Bank

Union Bank

Union Bank

of India

of India

of India

Admission to Post Graduate Programmes

Azim Premji University

Admission to Post Graduate Programmes

Azim Premji University

Date:

Admission to Post Graduate Programmes

Azim Premji University

Date:

Date:

Paid to the credit of Azim Premji University Current A/c Number 554301010050039
Union Bank PESSE Branch, Bangalore Hosur Road (1 km before Electronic City)
Bangalore - 560 100

Paid to the credit of Azim Premji University Current A/c Number 554301010050039
Union Bank PESSE Branch, Bangalore Hosur Road (1 km before Electronic City)
Bangalore - 560 100

Paid to the credit of Azim Premji University Current A/c Number 554301010050039
Union Bank PESSE Branch, Bangalore Hosur Road (1 km before Electronic City)
Bangalore - 560 100

Name of the Applicant :_____________________________________________

Name of the Applicant :_____________________________________________

Name of the Applicant :_____________________________________________

Address :

Address :

Address :

Fee Required Rs.250/For NEFT / RTGS - IFSC Code : UBINO555436. Branch Code : 026
Denomination

Fee Required Rs.250/For NEFT / RTGS - IFSC Code : UBINO555436. Branch Code : 026
Denomination

Fee Required Rs.250/For NEFT / RTGS - IFSC Code : UBINO555436. Branch Code : 026
Denomination

X 1000
X 500
X 100
X 50
X 10
X 5
Coins
Total

X 1000
X 500
X 100
X 50
X 10
X 5
Coins
Total

X 1000
X 500
X 100
X 50
X 10
X 5
Coins
Total

Total Rupees (in words) .............................................................................................

Total Rupees (in words) .............................................................................................

Total Rupees (in words) .............................................................................................

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

Signature of the Applicant :

Signature of the Applicant :

Signature of the Applicant :

(To be filled by the bank)

(To be filled by the bank)

Union Bank of India Branch Name :___________________________________

Branch Code

Deposit Date

Union Bank of India Branch Name :___________________________________

Branch Code

Note : For cash receipt, please mention the name of the candidate
in the remarks column.
Authorised Signatory

#Last date for Application fee receipt is Feb 10th 2012

(To be filled by the bank)

Deposit Date

Union Bank of India Branch Name :___________________________________

Branch Code

Note : For cash receipt, please mention the name of the candidate
in the remarks column.
Authorised Signatory

#Last date for Application fee receipt is Feb 10th 2012

Deposit Date

Note : For cash receipt, please mention the name of the candidate
in the remarks column.
Authorised Signatory

#Last date for Application fee receipt is Feb 10th 2012