Govt.

of West Bengal
Health & Family Welfare
e-Challan Form
GRN: 19-201617-003567919-2 Payment Mode : Counter Payment
GRN Date: 15/12/2016 22:35:56 Bank : State Bank of India

DEPOSITOR'S DETAILS
Name : SOUMYA BHATTACHARYA Id No. : 388318
[REF No]
Contact No.
E-mail : reek_sb@yahoo.co.in Mobile No. +91 9804316141
Address :
User Type :
Name WBHRB

From Date : 15/12/2016 To Date : 22/12/2016

Address

Remarks : Application Fee

PAYMENT DETAILS
Identification
Sl. No. Head of A/C Description Head of A/C Amount[ ]
No.
1 388318 West Bengal Health Recruitment 0051-00-104-002-16 210
Board Miscellaneous Receipts-
Other Fees

Total Amount 210

In Words : Rupees Two Hundred Ten only

Note: Produce this challan to any branch State Bank of India. Please ensure, to make
your payment within 22/12/2016 (banking hours).This challan form shall be invalid after 22/12/2016

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