NATIONAL BOARD OF EXAMINATIONS NATIONAL BOARD OF EXAMINATIONS NATIONAL BOARD OF EXAMINATIONS

Bank's Copy NBE’s Copy Depositors/Candidates Copy

Online Fees Account Online Fees Account Online Fees Account
Indian Bank A/c No. 830641451 Indian Bank A/c No. 830641451 Indian Bank A/c No. 830641451
NBE’S copy to be attached with the application form / Bank’s copy to be NBE’S copy to be attached with the application form / Bank’s copy to be NBE’S copy to be attached with the application form / Bank’s copy to be
retained by the Bank / Candidate’s copy to be retained by the candidate. retained by the Bank / Candidate’s copy to be retained by the candidate. retained by the Bank / Candidate’s copy to be retained by the candidate.

Challan No. …………………… Date: _ _ _ _ _ Challan No. …………………… Date: _ _ _ _ _ Challan No. …………………… Date: _ _ _ _ _

1. Name (in Capital letters): ____________________________ 1. Name (in Capital letters): ____________________________ 1. Name (in Capital letters): ____________________________
_____________________________________________________________ ______________________________________________________________ ______________________________________________________________

2. Sl. No. of Application Form ____________________________ 2. Sl. No. of Application Form ____________________________ 2. Sl. No. of Application Form ____________________________
(if applicable): ____________________________ (if applicable): ____________________________ (if applicable): ____________________________

3. Type of Fee / Amount 3. Type of Fee / Amount 3. Type of Fee / Amount

Code No. Code No. Code No.

01) CME WORKSHOP ___________ 01) CME WORKSHOP ___________ 01) CME WORKSHOP ___________

10) sale of Accreditation 10) sale of Accreditation 10) sale of Accreditation

02) THESIS FEE ___________ Application Form Fee _________ 02) THESIS FEE ___________ Application Form Fee _________ 02) THESIS FEE ___________ Application Form Fee _________

03) REGISTRATION FEE ___________ 11) Duplicate Certificate Fee 03) REGISTRATION FEE ___________ 11) Duplicate Certificate Fee 03) REGISTRATION FEE ___________ 11) Duplicate Certificate Fee
Result/Degree Result/Degree Result/Degree
04) ENROLMENT FEE ___________ _________ 04) ENROLMENT FEE ___________ _________ 04) ENROLMENT FEE ___________ _________
12) CET Centralized 12) CET Centralized 12) CET Centralized
05) IN-ABSENTIA FEE ___________ Counselling Fee _________ 05) IN-ABSENTIA FEE ___________ Counselling Fee _________ 05) IN-ABSENTIA FEE ___________ Counselling Fee _________

13) Post Diploma CET 13) Post Diploma CET 13) Post Diploma CET
06) Teleconferencing Fee ___________ Counselling _________ 06) Teleconferencing Fee ___________ Counselling _________ 06) Teleconferencing Fee ___________ Counselling _________

07) Teleconferencing DVD ___________ 14) Others Fee _________ 07) Teleconferencing DVD ___________ 14) Others Fee _________ 07) Teleconferencing DVD ___________ 14) Others Fee _________

08) Accreditation Fee ___________ 08) Accreditation Fee ___________ 08) Accreditation Fee ___________

09) Degree Verification Fee ___________ 09) Degree Verification Fee ___________ 09) Degree Verification Fee ___________

4. Bank Charges :-__________________________________ 4. Bank Charges :-__________________________________ 4. Bank Charges :-__________________________________

5. Amount (in Figure) :- _________________________________________ 5. Amount (in Figure) :- _________________________________________ 5. Amount (in Figure) :- _________________________________________

6. Amount (in words) ___________________________________________ 6. Amount (in words) ___________________________________________ 6. Amount (in words) ___________________________________________
_____________________________________________________________ ______________________________________________________________ ______________________________________________________________

7. Denomination of notes: 7. Denomination of notes: 7. Denomination of notes:

8. Bank Branch in which fee _____________________________________ 8. Bank Branch in which fee _____________________________________ 8. Bank Branch in which fee _____________________________________
____________________________________________________________ ____________________________________________________________ ____________________________________________________________

9. Bank Transaction ID No. 9. Bank Transaction ID No. 9. Bank Transaction ID No.

_______________________ _______________________ _______________________
(For Bank use only) (For Bank use only) (For Bank use only)

………………… ………………… ………………… ………………… ………………… …………………

Bank Seal & Signature of Authorized (Signature of the Candidate) Bank Seal & Signature of Authorized (Signature of the Candidate) Bank Seal & Signature of Authorized (Signature of the Candidate)
Bank Officer receiving the amount Bank Officer receiving the amount Bank Officer receiving the amount