(Applicant Copy) (UPHDB Copy) (Bank Copy)

Uttar Pradesh Housing and Development Board Uttar Pradesh Housing and Development Board Uttar Pradesh Housing and Development Board
AE - 2016 AE - 2016 AE - 2016

CMS CODE: UPEVKP8962 CMS CODE: UPEVKP8962 CMS CODE: UPEVKP8962

Cash can be tendered at any branch of HDFC Bank Cash can be tendered at any branch of HDFC Bank Cash can be tendered at any branch of HDFC Bank

Application No : AE2016002582 Application No : AE2016002582 Application No : AE2016002582

Applicant Name : VIJAY KUMAR Applicant Name : VIJAY KUMAR Applicant Name : VIJAY KUMAR

Date of Birth Date of Birth Date of Birth

(DD/MM/YYYY) : 20/Aug/1987 (DD/MM/YYYY) : 20/Aug/1987 (DD/MM/YYYY) : 20/Aug/1987

Mobile No : 8130096763 Mobile No : 8130096763 Mobile No : 8130096763

Amount (Rs.) : 500.00/- Amount (Rs.) :500.00 Amount (Rs.) : 500.00

Amount in words: Five Hundred only Amount in words: Five Hundred only Amount in words: Five Hundred only

CASH DENOMINATION CASH DENOMINATION CASH DENOMINATION

1000 x ________ = _______________ 1000 x ________ = _______________ 1000 x ________ = _______________
500 x ________ = _______________ 500 x ________ = _______________ 500 x ________ = _______________
100 x ________ = _______________ 100 x ________ = _______________ 100 x ________ = _______________
50 x ________ = _______________ 50 x ________ = _______________ 50 x ________ = _______________
20 x ________ = _______________ 20 x ________ = _______________ 20 x ________ = _______________
10 x ________ = _______________ 10 x ________ = _______________ 10 x ________ = _______________

To be lled by Bank To be lled by Bank To be lled by Bank

HDFC Branch Name : HDFC Branch Name : HDFC Branch Name :

Deposit Date : Deposit Date : Deposit Date :

Signature of Bank ofcial : Signature of Bank ofcial : Signature of Bank ofcial :

Branch Stamp : Branch Stamp : Branch Stamp :