CHALLAN FORM (CASH VOUCHER) CHALLAN FORM (CASH VOUCHER)

BRANCH COPY CANDIDATES COPY

______________BANK ______________BANK Place for

Application Fee Details Application Fee Details

Recruitment of Officer / Office Assistant Recruitment of Officer / Office Assistant Candidates

in Langpi Dehangi Rural Bank in Langpi Dehangi Rural Bank Photograph

Account No : 98000363374

at __________________ Branch Account No : 98000363374

Candidates Name : Mr./Mrs/Kum. at _________________ Branch

Category* SC/ST/PC/EXS Application Fee/Postage Rs 20/- Candidates Name : Mr./Mrs/Kum.

OBC/GEN - Application Fee & Postage Rs. 100/- Category* SC/ST/PC/EXS Application Fee/Postage Rs 20/-

Date of Birth

: OBC/GEN - Application Fee & Postage Rs. 100/-

Date of Birth :

Banks Branch Name :

Banks Branch Name :

Branch Code No#

:

Branch Code No# :

Journal No #

:

(7 to 10 digits) Journal No # :

Deposit Date : (7 to 10 digits)

Deposit Date :

Application Fee/Postage Rs

(Rupees.......................................................................................... only) Application Fee/Postage Rs........................

(Rupees.......................................................................................... only)

Signature of Depositor Authorized Signatory (Bank)

Address:.................... Stamp Signature of Depositor Authorized Signatory (Bank)

.... ... .... ... ... ... ... ... .... ... .. Address:.................... Stamp Phone/Mobile. No. ...................................

Phone/Mobile. No.

* Tick whichever is applicable. * Tick whichever is applicable.

# Fee receiving branch is advised to write the Deposit Journal No. and # Fee receiving branch is advised to write the Deposit Journal No. and

branch code no. above invariably. branch code no. above invariably.

(This part of the challan will be required to be submitted by the candidate at the time of

interview along with a photograph, otherwise the candidate will not be allowed to appear

at the examination.)