(ENCLOSURE III)

STUDENTS COPY

SCDL COPY

BANKS COPY

SYMBIOSIS

SYMBIOSIS

SYMBIOSIS

CENTRE FOR DISTANCE LEARNING

CENTRE FOR DISTANCE LEARNING

CENTRE FOR DISTANCE LEARNING

EXAM FEE CHALLAN

JAN / FEB 2007

EXAM FEE CHALLAN

JAN / FEB 2007

EXAM FEE CHALLAN

JAN / FEB 2007

Challan No.:

Challan No.:

Challan No.:

A/c Code : SYMBDL

Branch Name :________________
(To be treated by the student as Exam Fee Receipt)

A/c Code : SYMBDL

Date of Receipt

Date of Receipt

_____/____/2006

University / School :

SCDL

Branch Name :________________

_____/____/2006

University / School :

SCDL

A/c Code : SYMBDL

Date of Receipt

Branch Name :________________

_____/____/2006

University / School :

SCDL

Student Name :

____________________________________

Student Name :

____________________________________

Student Name :

____________________________________

Roll No./Reg.No.:

____________________________________

Roll No./Reg.No.:

____________________________________

Roll No./Reg.No.:

____________________________________

Student Tel/Cell. No.: ____________________________________

Student Tel/Cell. No.: ____________________________________

Student Tel/Cell. No.: ____________________________________

Email

Email

Email

____________________________________

____________________________________

____________________________________

Batch Year /Course : ____________________________________

Batch Year /Course : ____________________________________

Batch Year /Course : ____________________________________

Exam Centre & City : ____________________________________

Exam Centre & City : ____________________________________

Exam Centre & City : ____________________________________

Type of Fee : Exam Fee

(Please furnish details of the subjects overleaf)

Type of Fee : Exam Fee

(Please furnish details of the subjects overleaf)

Type of Fee : Exam Fee

(Please furnish details of the subjects overleaf)

No. of Subjects appearing for : ________X 125 per subject

No. of Subjects appearing for : ________X 125 per subject

No. of Subjects appearing for : ________X 125 per subject

Total Exam Fees : ______________________________________

Total Exam Fees : ______________________________________

Total Exam Fees : ______________________________________

Total Fee Amount : ______________________________________

Total Fee Amount : ______________________________________

Total Fee Amount : ______________________________________

Amount in words : ______________________________________

Amount in words : ______________________________________

Amount in words : ______________________________________

Mode of Payment :

Mode of Payment :

Mode of Payment :

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Cash

________________________
Signature of Bank Official

__________________________
Signature of Depositor/Student

Please indicate the subject codes for which you have

remitted the Exam Fee

Please indicate the subject codes for which you have

remitted the Exam Fee

Please indicate the subject codes for which you have

remitted the Exam Fee

1_________________ 10_________________

1_________________ 10_________________

1_________________ 10_________________

2_________________ 11_________________

2_________________ 11_________________

2_________________ 11_________________

3_________________ 12_________________

3_________________ 12_________________

3_________________ 12_________________

4_________________ 13_________________

4_________________ 13_________________

4_________________ 13_________________

5_________________ 14_________________

5_________________ 14_________________

5_________________ 14_________________

6_________________ 15_________________

6_________________ 15_________________

6_________________ 15_________________

7_________________ 16_________________

7_________________ 16_________________

7_________________ 16_________________

8_________________ 17_________________

8_________________ 17_________________

8_________________ 17_________________

9_________________ 18_________________

9_________________ 18_________________

9_________________ 18_________________

Other Remarks :________________________

_____________________________________
_____________________________________
_____________________________________

Other Remarks :________________________

_____________________________________
_____________________________________
_____________________________________

Other Remarks :________________________

_____________________________________
_____________________________________
_____________________________________

Particulars of Cash Deposited :Cash Deposit

DENO
PIECES
1000 X

Particulars of Cash Deposited :Cash Deposit

DENO
PIECES
1000 X

Particulars of Cash Deposited :Cash Deposit

DENO
PIECES
1000 X

Rs.

Ps.

Rs.

Ps.

500 X

500 X

500 X

100 X

100 X

100 X

50

50

50

20

20

20

10

10

10

COINS

COINS

COINS

TOTAL

TOTAL

TOTAL

Rs.

Ps.