Bank's Copy

Institution's Copy

Student/Applicant's Copy

B M GROUP OF INSTITUTIONS
F A R R U K H N A G A R G U R G A O N ( H R ) - 1 2 2 5 0 6

B M GROUP OF INSTITUTIONS
F A R R U K H N A G A R G U R G A O N ( H R ) - 1 2 2 5 0 6

B M GROUP OF INSTITUTIONS
F A R R U K H N A G A R G U R G A O N ( H R ) - 1 2 2 5 0 6

The PAN NO. of the Education Institution Name of branch: Date of Deposit:

AABTM5849A

The PAN NO. of the Education Institution Name of branch: Date of Deposit:

AABTM5849A

The PAN NO. of the Education Institution Name of branch: Date of Deposit:

AABTM5849A

D D/M M/Y Y Y Y (to be treated by student / Donor as fee receipt) Account to be credited 1. Institution Name 2.Student's Name 3. Roll no 4. Class/ Branch 5. Course 6. Contact No. 7. Amount 8. Amount in words 9. Cash Details: Denomination 1000 X 500 X 100 X 50 X 20 X 10 X 5X Coins Total Amount Particulars College Fee Hostel Fee Transport Fee Others Bank Charge TOTAL Rs. : : : : : : : 0 0 3 6 S L F E E C O L F C B C T M

D D/M M/Y Y Y Y (to be treated by student / Donor as fee receipt) Account to be credited 1. Institution Name 2.Student's Name 3. Roll no 4. Class/ Branch 5. Course 6. Contact No. 7. Amount : : : : : : : 0 0 3 6 S L F E E C O L F C B C T M

D D/M M/Y Y Y Y (to be treated by student / Donor as fee receipt) Account to be credited 1. Institution Name 2.Student's Name 3. Roll no 4. Class/ Branch 5. Course 6. Contact No. 7. Amount : : : : : : : 0 0 3 6 S L F E E C O L F C B C T M

Rupees .. Only

8. Amount in words 9. Cash Details: Denomination 1000 X 500 X 100 X 50 X 20 X 10 X 5X Coins Total

Rupees .. Only
Particulars College Fee Hostel Fee Transport Fee Others Bank Charge TOTAL Rs.

8. Amount in words 9. Cash Details:

Rupees .. Only
Particulars College Fee Hostel Fee Transport Fee Others Bank Charge TOTAL Rs.

Amount

Denomination 1000 X 500 X 100 X 50 X 20 X 10 X 5X Coins Total

Amount

Cheque* / Payorder / DD No.

Drawn On Bank

Cheque* / Payorder / DD No.

Drawn On Bank

Cheque* / Payorder / DD No.

Drawn On Bank

Payable At Branch:

Payable At Branch:

Payable At Branch:

Signature/ Stamp ICICI Bank Ltd

Signature of Depositor

Signature/ Stamp ICICI Bank Ltd

Signature of Depositor

Signature/ Stamp ICICI Bank Ltd

Signature of Depositor

* must be drawn payable at the centre of deposit of the instrument I.e. outstation instruments not acceptable

* must be drawn payable at the centre of deposit of the instrument I.e. outstation instruments not acceptable

* must be drawn payable at the centre of deposit of the instrument I.e. outstation instruments not acceptable