Bank Copy T&P Copy Student Copy

punjab national bank punjab national bank punjab national bank

Branch IIT Roorkee Branch IIT Roorkee Branch IIT Roorkee
Customer Name Indian Institute of Technology Roorkee Customer Name Indian Institute of Technology Roorkee Customer Name Indian Institute of Technology Roorkee
Training and Placement Office Training and Placement Office Training and Placement Office
Account No. 4044000100014615 Account No. 4044000100014615 Account No. 4044000100014615
Date of Deposit Date of Deposit Date of Deposit
DD MM YY DD MM YY DD MM YY

Enrollment No. Enrollment No. Enrollment No.

Student Student Student

Name Name Name

Course Branch/ Course Branch/ Course Branch/

Specialization Specialization Specialization

Category Mobile No. Category Mobile No. Category Mobile No.

E-mail E-mail E-mail

Fee details Gen/OBC SC/ST/PH Fee details Gen/OBC SC/ST/PH Fee details Gen/OBC SC/ST/PH
Rs. 1500 Rs. 1000 Rs. 1500 Rs. 1000 Rs. 1500 Rs. 1000

Cash Deposit: Cheque Deposit: Cash Deposit: Cheque Deposit: Cash Deposit: Cheque Deposit:
Denomination Rs. Chq No. Denomination Rs. Chq No. Denomination Rs. Chq No.
2000 x Date of Chq 2000 x Date of Chq 2000 x Date of Chq
500 x Name of Bank 500 x Name of Bank 500 x Name of Bank
100 x Rs. 100 x Rs. 100 x Rs.
50 x 50 x 50 x
20 x 20 x 20 x
10 x 10 x 10 x
5x 5x 5x
Coins x Coins x Coins x
Total Total Total

Amount (in words): Rs. ________________________________________ Amount (in words): Rs. ________________________________________ Amount (in words): Rs. ________________________________________

___________________________________________________________ ___________________________________________________________ ___________________________________________________________

Name of Depositor Signature of Depositor Name of Depositor Signature of Depositor Name of Depositor Signature of Depositor

For Bank use only For Bank use only For Bank use only

Acknowledgement Cashier/Officer Acknowledgement Cashier/Officer Acknowledgement Cashier/Officer