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Application No. .........................

BRANCH COPY

Admission to Post Graduate Programmes

Authorised Signatory

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Date:

Account No: 31645699196 Azim Premji Universit y - Fee A/c atSpecialized Mid Corporate branch, Kumara Park, Bangalore 560020,Branch Code No.:14125

Date:

Account No: 31645699196 Azim Premji University - Fee A/c atSpecialized Mid Corporate branch, Kumara Park, Bangalore 560020,Branch Code No.:14125

Date:

Account No: 31645699196 Azim Premji University - Fee A/c atSpecialized Mid Corporate branch, Kumara Park, Bangalore 560020,Branch Code No.:14125

Name of the Applicant :_____________________________________________

Address :

Fee Required Rs.250/ - (plus Bank Charges of Rs.25/- extra)

Signature of the Applicant :

(To be fi lled by t he bank)

Branch Stamp

SBI Branch Name :___________________________________

Branch Code Deposit Date

Journal No.

#Last date for Application fee receipt is Feb 10th 2012

STATE BANK OF INDIA

Admission to Post Graduate Programmes

Authorised Signatory

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Name of t he Applicant :_____________________________________________

Address :

Fee Required Rs.250/ - (plus Bank Charges of Rs.25/- extra)

Signature of the Applicant :

(To be fi lled by t he bank)

Branch Stamp

SBI Branch Name :___________________________________

Branch Code Deposit Date

Journal No.

#Last date for Application fee receipt is Feb 10th 2012

STATE BANK OF INDIA

Admission to Post Graduate Programmes

Authorised Signatory

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Name of t he Applicant :_____________________________________________

Address :

Fee Required Rs.250/ - (plus Bank Charges of Rs.25/- extra)

Signature of the Applicant :

(To be fi lled by t he bank)

Branch Stamp

SBI Branch Name :___________________________________

Branch Code Deposit Date

Journal No.

#Last date for Application fee receipt is Feb 10th 2012

STATE BANK OF INDIA

Application No. .........................

AZIM PREMJI UNIVERSITY COPY

Application No. .........................

APPLICANTSCOPY

8/2/2019 ajim premji

2/2

Application No. .........................

BRANCH COPY

Application No. .........................

AZIM PREMJI UNIVERSITY COPY

Application No. .........................

APPLICANTSCOPY

X 1000

X 500

X 100

X 50

X 10

X 5

Coins

Total

Admission to Post Graduate Programmes

Authorised Signatory

Note : For cash receipt, pl ease mention t he name of the candidate

in the remarks column.

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Date:

Paid to t he credit of Azim Premji Universit y Current A/c Number 554301010050039Union Bank PESSEBranch, Bangalore Hosur Road (1 km before Electronic City)Bangalore - 560 100

Name of the Applicant :_____________________________________________

Address :

Fee Required Rs.250/-For NEFT / RTGS- IFSCCode : UBINO555436. Branch Code : 026Denomination

Signature of the Applicant :

Total Rupees (in words) .............................................................................................

...................................................................................................................................

(To be fi lled by t he bank)

Union Bank of India Branch Name :___________________________________

Branch Code Deposit Date

#Last date for Application fee receipt is Feb 10th 2012

Union Bankof India

X 1000

X 500

X 100

X 50

X 10

X 5

Coins

Total

Admission to Post Graduate Programmes

Authorised Signatory

Note : For cash receipt, please mention the name of the candidate

in t he remarks column.

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Date:

Paid to the credit of Azim Premji University Current A/c Number 554301010050039Union Bank PESSEBranch, Bangalore Hosur Road (1 km before Electronic City)Bangalore - 560 100

Name of the Applicant :_____________________________________________

Address :

Fee Required Rs.250/-For NEFT / RTGS- IFSCCode : UBINO555436. Branch Code : 026Denomination

Signature of the Applicant :

Total Rupees (in words) .............................................................................................

...................................................................................................................................

(To be fi lled by t he bank)

Union Bank of India Branch Name :___________________________________

Branch Code Deposit Date

#Last date for Application fee receipt is Feb 10th 2012

Union Bankof India

X 1000

X 500

X 100

X 50

X 10

X 5

Coins

Total

Admission to Post Graduate Programmes

Authorised Signatory

Note : For cash receipt, please mention the name of the candidate

in the remarks column.

APPLICATION FEEPAYMENT CHALLAN

Azim Premji University

Date:

Paid to t he credit of Azim Premji University Current A/c Number 554301010050039Union Bank PESSEBranch, Bangalore Hosur Road (1 km before Electronic City)Bangalore - 560 100

Name of t he Applicant :_____________________________________________

Address :

Fee Required Rs.250/-For NEFT / RTGS- IFSCCode : UBINO555436. Branch Code : 026Denomination

Signature of the Applicant :

Total Rupees (in words) .............................................................................................

...................................................................................................................................

(To be fi lled by t he bank)

Union Bank of India Branch Name :___________________________________

Branch Code Deposit Date

#Last date for Application fee receipt is Feb 10th 2012

Union Bankof India