PAYMENT CHALLAN - FORMAT

APPLICATION FEE / INTIMATION CHARGES PAYMENT CHALLAN BRANCH COPY APPLICATION FEE / INTIMATION CHARGES PAYMENT CHALLAN CANDIDATE COPY

Application Fee / Intimation Charges Details Recruitment Project 2 / 2012 Probationary Clerks T O B E F I L L E D - I N B Y T H E C A N D I D AT E IBPS-CWE-CLERK-2011-12 Registration No. : Mr. / Mrs. / Kum Applicants Name : Date of Birth [DD-MM-YYYY] Contact Phone No Category* [Tick appropriate box] Post Applied for Amount deposited : : ` 50/: : :
SC ST PWD

Application Fee / Intimation Charges Details Recruitment Project 2 / 2012 Probationary Clerks T O B E F I L L E D - I N B Y T H E C A N D I D AT E IBPS-CWE-CLERK-2011-12 Registration No. : Mr. / Mrs. / Kum Applicants Name : Date of Birth [DD-MM-YYYY] Contact Phone No ` 100/All Others

: : ` 50/: : :
SC ST PWD

Category* [Tick appropriate box] Post Applied for Amount deposited

` 100/All Others

Probationary Clerk ` _______/[Rupees _______________________only]

Probationary Clerk ` _______/[Rupees _______________________only]

Depositing Branch Name & City : T O B E F I L L E D - I N B Y T H E B R A N C H O F F I C I AL S Canara Bank, South End Road, Bangalore Payee Branch Name : [DP Code-1173] Canara Bank Recruitment Project-2/2012 Name of the Account : Probationary Clerks Account Number : 1173201002265 D P Code of Branch where Fees / : Intimation Charges Paid Transaction Sequence No. : Date of Deposit [shall be between :
18.06.2012 and 01.07.2012]

18.06.2012 and 01.07.2012]

Depositing Branch Name & City : T O B E F I L L E D - I N B Y T H E B R A N C H O F F I C I AL S Canara Bank, South End Road, Bangalore Payee Branch Name : [DP Code-1173] Canara Bank Recruitment Project-2/2012 Name of the Account : Probationary Clerks Account Number : 1173201002265 D P Code of Branch where Fees / : Intimation Charges Paid Transaction Sequence No. : Date of Deposit [shall be between :

Signature of Depositor

Authorised Signatory Branch Seal:__________

Signature of Depositor

Authorised Signatory Branch Seal:__________

Note to the Branch: (1) Write Transaction Sequence No. & Branch DP Code No. above invariably,
only after the transaction is authorized & successful and then only copy should be given to Candidate. (2) Transaction Sequence No. should not be prefixed or suffixed with any other numbers. (3) Only Registration No. of the candidate should be entered in Narration field in CBS.

Note to the candidates: 1) Please check whether the Transaction Sequence No., Branch DP Code
No & Date of Deposit are entered properly & signed by the Branch Officials (2) Candidate has to submit this challan at the time of Group Discussion & Interview.