(Candidate Copy)

(Bank Copy)

JEE(Main)-2017

JEE(Main)-2017

Cash can be deposited at any CBS Branch of ICICI Bank

Cash can be deposited at any CBS Branch of ICICI Bank

Bank A/C No. :

Application No.:

JEE(Main)-2017 Fee A/C

Bank A/C No. :

Application No.:

JEE(Main)-2017 Fee A/C

Name :

RITTIK DAS

Name :

Date of Birth :
Category :
Person with Disability (PwD) :
Course :
Mobile No. :
Fee Rs :
Printed on :

RITTIK DAS

14/12/1998
GENERAL
NO
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
9674293096
1000/30-12-2016 11:33:18 AM

Date of Birth :
Category :
Person with Disability (PwD) :
Course :
Mobile No. :
Fee Rs :
Printed on :

14/12/1998
GENERAL
NO
JEE(Main) Paper - 1 (B.E./B.Tech.) Only
9674293096
1000/30-12-2016 11:33:18 AM

70950548

Signature of the Depositor

----

70950548

Signature of the Depositor

Instructions for ICICI Bank Branches
1. This is an I Sure Pay Challan & Inst Code/ Account No. not required
2. Type "HCOREFEE" in finacle --> Select "JEE(Main)-2017 CBSE" --> Enter "Application No.:" -> Click Submit --> Verify Details --> Accept Cash --> Click Submit -->Generate Receipt -->
Handover to Depositor.

(To be filled by the bank)

(To be filled by the bank)

Branch Name:

Branch Name:

Branch Code:

Branch Code:

Transaction Id:

Transaction Id:

Deposit Date:
______/______/20_____

Deposit Date:
______/______/20_____

Authorized Signatory

Authorized Signatory

Branch Stamp
Candidate should revisit the website to download Acknowledgement Page after depositing the fee.

Branch Stamp
Bank official is requested to enter Application No. and Name of candidate only in narrative column.