APPLICATION FEE / POSTAL CHARGES PAYMENT CHALLAN APPLICATION FEE / POSTAL CHARGES PAYMENT CHALLAN

BRANCH COPY CANDIDATE COPY

Application Fee / Postal Charges Details Application Fee / Postal Charges Details
Recruitment Project – 3 / 2010 – Specialist Officers Recruitment Project – 3 / 2010 – Specialist Officers
TO BE FILLED-IN BY THE CANDIDATE TO BE FILLED-IN BY THE CANDIDATE
Mr. / Mrs. / Kum Mr. / Mrs. / Kum
Applicant’s Name : Applicant’s Name :

Date of Birth [DD-MM-YYYY] : Date of Birth [DD-MM-YYYY] :

Contact Phone No : Contact Phone No :
` 50/-
50/ - ` 300/-
300/- ` 50/-
50/ - ` 300/-
300/-
Category* Category*
: SC ST PWD All Others : SC ST PWD All Others
[Tick appropriate box] [Tick appropriate box]

Post Applied for : Post Applied for :

Post Code : Post Code :
` _______/- ` _______/-
Amount deposited : Amount deposited :
[Rupees _________________________only] [Rupees _________________________only]
Depositing Branch Name & City : Depositing Branch Name & City :
TO BE FILLED-IN BY THE BRANCH OFFICIALS TO BE FILLED-IN BY THE BRANCH OFFICIALS
D P Code of Branch where Fees / D P Code of Branch where Fees /
: :
Postage Paid Postage Paid
Canara Bank, South End Road, Bangalore Canara Bank, South End Road, Bangalore
Payee Branch Name : Payee Branch Name :
[DP Code-1173] [DP Code-1173]
Name of the Account : Canara Bank Recruitment Project – 3/2010 Name of the Account : Canara Bank Recruitment Project – 3/2010
Account Number : 1173201002158 Account Number : 1173201002158
Transaction Sequence No. : Transaction Sequence No. :
Date of Deposit [shall be between Date of Deposit [shall be between
: :
25.08.2010 and 20.09.2010] 25.08.2010 and 20.09.2010]

Signature of Depositor Authorised Signatory Signature of Depositor Authorised Signatory

SP No:___________ & SP No:___________ &
Branch Seal:__________ Branch Seal:__________
* Tick whichever is applicable. * Tick whichever is applicable.
Note: Fee receiving branch is advised to write Transaction Sequence No. & Branch DP Note: Fee receiving branch is advised to write Transaction Sequence No. & Branch DP
Code No. above invariably Code No. above invariably