CHALLAN FORM (CASH VOUCHER) CHALLAN FORM (CASH VOUCHER)

BRANCH COPY CANDIDATE’S COPY

STATE BANK OF INDIA- 01 STATE BANK OF INDIA- 01
Application Fee Details Application Fee Details Affix Passport
Recruitment of Officer Scale-I Recruitment of Officer Scale-I size Photograph
in Madhya Bharat Gramin Bank in Madhya Bharat Gramin Bank

Account No : 31459579685 Account No :

31459579685
at SBI Gopalganj, Sagar Branch ( code- 07214) at SBI Gopalganj, Sagar Branch ( code- 07214 )
Candidate’s Name : Mr./Mrs/Kum. Candidate’s Name : Mr./Mrs/Kum.

Category* : SC/ST – Rs. 50.00 + 25.00** = 75.00 Category* : SC/ST – Rs. 50.00 + 25.00** = 75.00
OBC/GEN - Rs. 500.00 + 25.00** = 525.00 OBC/GEN - Rs. 500.00 + 25.00** = 525.00

Date of Birth : Date of Birth :

SBI Branch Name : SBI Branch Name :

Branch Code No# : Branch Code No# :

Journal No # : Journal No # :
(7 to 10 digits) (7 to 10 digits)

Deposit Date : Deposit Date :

Amount Rs. ....................... Amount Rs. .......................

(Rupees..........................................................................................only) (Rupees..........................................................................................only)

Signature of Depositor Authorized Signatory Signature of Depositor Authorized Signatory

Address:....................
...................................
Phone/Mob. No.
* Tick whichever is applicable.
** Inter core transaction charges.
# Fee receiving branch is advised to write the Deposit Journal No. and
branch code no. above invariably.
Stamp Address:.................... Stamp
...................................
Phone/Mob. No.
* Tick whichever is applicable.
** Inter core transaction charges.
# Fee receiving branch is advised to write the Deposit Journal No. and
branch code no. above invariably.
(This part of the challan will be required to be submitted by the candidate at the time of
written test along with a photograph, otherwise the candidate will not be allowed to appear
at the examination.)