Bank Challan Form

Karnataka State Open University, Mysore
Name of the Bank &
Place of Remittance .......................................................................
Name of the Course .......................................................................
Class : I / II / III Year
NOTE: Please key in Roll No. before affording credit
Subject: Roll No:
ORIGINAL
State Bank of Mysore
(Code: 40166)
Manasagangotri, Mysore-570 006
State Bank of India
(Code: 3130)
New Sayyaji Rao Road, Mysore-01
KSOU-500-EXAMINATION FUND
SBM - 54035420128 SBI- 31106997538
Name and Address of the Student :
Code No: Amount Rs.
501: Examination Fee :
502: Revaluation / Retotaling/Improvement Fee :
503: Rank / Provisional Certificate Fee :
504: Convocation Fee :
505: Genuine/Migration Certificate Fee :
506: Miscellaneous Fee (Specify) :
.........................................................
Total
Amount (in words) Rupees ....................................................................................................
.....................................................................................................................
Note: Fees once paid will not be Refunded.
Date: Signature of the Remitter
For the use of the Bank
The Amount of Rupees (in words)........................................................................................
.....................................................................................................
...........................................................................................................................................................................
has been received
Challan No.
Date & Signature of the Officer
Bank Seal receiving the money
To be retained with the receiving Bank
Karnataka State Open University, Mysore
Name of the Bank &
Place of Remittance .......................................................................
Name of the Course .......................................................................
Class : I / II / III Year
NOTE: Please key in Roll No. before affording credit
Subject: Roll No:
DUPLICATE
State Bank of Mysore
(Code: 40166)
Manasagangotri, Mysore-570 006
State Bank of India
(Code: 3130)
New Sayyaji Rao Road, Mysore-01
KSOU-500-EXAMINATION FUND
SBM - 54035420128 SBI- 31106997538
Name and Address of the Student :
Code No: Amount Rs.
501: Examination Fee :
502: Revaluation / Retotaling/Improvement Fee :
503: Rank / Provisional Certificate Fee :
504: Convocation Fee :
505: Genuine/Migration Certificate Fee :
506: Miscellaneous Fee (Specify) :
.........................................................
Total
Amount (in words) Rupees ....................................................................................................
.....................................................................................................................
Note: Fees once paid will not be Refunded.
Date: Signature of the Remitter
For the use of the Bank
The Amount of Rupees (in words)........................................................................................
. ....................................................................................................
...........................................................................................................................................................................
has been received
Challan No.
Date & Signature of the Officer
Bank Seal receiving the money
To be sent to State Bank Of Mysore, Manasagangotri Branch, Mysore - 570 006 and
State Bank Of India, New Sayyaji Rao Road, Mysore - 1,
by the receiving Bank along with M.T. and Statement
Karnataka State Open University, Mysore
Name of the Bank &
Place of Remittance .......................................................................
Name of the Course .......................................................................
Class : I / II / III Year
NOTE: Please key in Roll No. before affording credit
Subject: Roll No:
TRIPLICATE
State Bank of Mysore
(Code: 40166)
Manasagangotri, Mysore-570 006
State Bank of India
(Code: 3130)
New Sayyaji Rao Road, Mysore-01
KSOU-500-EXAMINATION FUND
SBM - 54035420128 SBI- 31106997538
Name and Address of the Student :
Code No: Amount Rs.
501: Examination Fee :
502: Revaluation / Retotaling/Improvement Fee :
503: Rank / Provisional Certificate Fee :
504: Convocation Fee :
505: Genuine/Migration Certificate Fee :
506: Miscellaneous Fee (Specify) :
.........................................................
Total / MlÄÖ gÀÆ.
Amount (in words) Rupees ....................................................................................................
.....................................................................................................................
Note: Fees once paid will not be Refunded.
Date: Signature of the Remitter
For the use of the Bank
The Amount of Rupees (in words)........................................................................................
.....................................................................................................
...........................................................................................................................................................................
has been received
Challan No.
Date & Signature of the Officer
Bank Seal receiving the money
(To be issued to the Remitter) (Student should send this copy to the University Compulsorily)
Karnataka State Open University, Mysore
Name of the Bank &
Place of Remittance .......................................................................
Name of the Course .......................................................................
Class : I / II / III Year
NOTE: Please key in Roll No. before affording credit
Subject: Roll No:
QUADRUPLICATE
State Bank of Mysore
(Code: 40166) PÉÆÃqï : 40166
Manasagangotri, Mysore-570 006
State Bank of India
(Code: 3130)
New Sayyaji Rao Road, Mysore-01
KSOU-500-EXAMINATION FUND
SBM - 54035420128 SBI- 31106997538
Name and Address of the Student :
Code No: Amount Rs.
501: Examination Fee :
502: Revaluation / Retotaling/Improvement Fee :
503: Rank / Provisional Certificate Fee :
504: Convocation Fee :
505: Genuine/Migration Certificate Fee :
506: Miscellaneous Fee (Specify) :
.........................................................
Total
Amount (in words) Rupees ....................................................................................................
.....................................................................................................................
Note: Fees once paid will not be Refunded.
Date: Signature of the Remitter
For the use of the Bank
The Amount of Rupees (in words)........................................................................................
....................................................................................................
...........................................................................................................................................................................
has been received.
Challan No.
Date & Signature of the Officer
Bank Seal receiving the money
(Student Copy to be retained by the student) (No separate receipt will be issued)