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

BRANCH COPY CANDIDATE’S COPY


STATE BANK OF INDIA STATE BANK OF INDIA
Application Fee Details Application Fee Details
Recruitment of Officer Scale-I(Group ‘A’) Recruitment of Officer Scale-I(Group ‘A’)
in Uttaranchal Gramin Bank in Uttaranchal Gramin Bank
Affix Passport
Account No : 31580588894 Account No : 31580588894 Size Photograph
Candidate’s Name : Candidate’s Name :
(Mr./Mrs/Kum.) …………………………………………………………. (Mr./Mrs/Kum.)
………………………………………………………
Category* SC/ST/PC- Rs 75/-
OBC/GEN - Rs. 325/- Category* SC/ST/PC- Rs 75/-
OBC/GEN - Rs. 325/-
Date of Birth :_______/__________/_________
Date of Birth :_______/__________/_________
SBI Branch Name :
SBI Branch Name :
Branch Code No# :
Branch Code No# :
Journal No # :
(7 to 10 digits) Journal No # :
(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:.................................. Stamp Address:........................................... Stamp

................................................. ...........................................................
Phone/Mobi. No. Phone/Mobi. No.
* Tick whichever is applicable. * Tick whichever is applicable.
# Fee receiving branch is advised to write the Deposit Journal No. and # Fee receiving branch is advised to write the Deposit Journal No. and
branch code no. above invariably. branch code no. above invariably.

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