Depositor Copy Branch Copy

Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch Date: 03-01-2016 Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch

Beneficiary/Remittance Details Branch Teller: Use SCR 008765 Deposit > Fee Collection > State Bank Collect
State Bank Collect Reference No. DU36478181 Date: 03-01-2016

Beneficiary: IIT ROORKEE

Beneficiary/Remittance Details
Category: IIT Roorkee Semester Fee
State Bank Collect Reference No. DU36478181
Last Date of Payment: 11-02-2016 23:45
Beneficiary: IIT ROORKEE
Remitter Rahul Ratan Mirdha
Category: IIT Roorkee Semester Fee
Rs
Last Date of Payment: 11-02-2016 23:45
Collection Amount 68,600.00
Remitter Rahul Ratan Mirdha
Comission 57.00
Total (Rupees Sixty Eight Thousand Six Hundred Fifty Seven Only) 68,657.00 Rs
Collection Amount 68,600.00
Details of Cash / Cheques Rs p Comission 57.00
Total (Rupees Sixty Eight Thousand Six Hundred Fifty Seven Only) 68,657.00
Mode of Payment (Choose Either Cash / Cheque)

Total Rs Cash PAN:

Instructions for Depositor: This is not an e-receipt. After payment , please visit www.onlinesbi.com > 'State Bank Please quote your PAN for Cash remittance >= Rs. 50,000
Collect' and click on the hyperlink at the bottom of the page to generate the e-receipt.
Amount
Cash Notes Rs P
*1000
*500
*100
(To be Filled in by the Bank) *50
*20
Journal No: DU36478181
*10

Branch Name: Coins

Total Rs
Branch Code: Deposit Date:
Cheque

Branch Stamp Cheque No: Cheque Date:

Drawee Bank: State Bank of India (other bank cheques not accepted under PAP)
Branch:
Authorised Signatory
Signature of the Depositor

Space for Bank use

Branch Stamp