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Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch

Branch Teller: Use SCR 008765 Deposit > Fee Collection > State Bank Collect

Cheque No: Cheque Date:

Drawee Bank: State Bank of India (other bank cheques not accepted under PAP)

Branch:

Space for Bank use

Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch

Beneficiary/Remittance Details

State Bank Collect Reference No. DU36265629

Beneficiary: INDIAN INSTITUTE OF TECHNOLOGY, HYDERABAD

Category: 2nd SEMESTER and ABOVE (Old Students)

Remitter RAJ KUMAR SHARMA

Rs

Collection Amount 33,650.00

Comission 57.00

Total (Rupees Thirty Three Thousand Seven Hundred Seven Only) 33,707.00

(To be Filled in by the Bank)

Branch Name:

Date: 28-12-2015

Depositor Copy

pRsDetails of Cash / Cheques

Total Rs

Instructions for Depositor: This is not an e-receipt. After payment , please visit > 'State Bankwww.onlinesbi.com

Collect' and click on the hyperlink at the bottom of the page to generate the e-receipt.

DU36265629Journal No:

Deposit Date:Branch Code:

Branch Stamp

Authorised Signatory

Branch Copy

Date: 28-12-2015

Beneficiary/Remittance Details

State Bank Collect Reference No. DU36265629Beneficiary: INDIAN INSTITUTE OF TECHNOLOGY, HYDERABAD

Category: 2nd SEMESTER and ABOVE (Old Students)

Remitter RAJ KUMAR SHARMA

Rs

Collection Amount 33,650.00

Comission 57.00

Total (Rupees Thirty Three Thousand Seven Hundred Seven Only) 33,707.00

Cheque

Cash

(Choose Either Cash / Cheque)Mode of Payment

PAN:

Please quote your PAN for Cash remittance >= Rs. 50,000

Cash Notes Rs PAmount

*1000

*500

*100

*50

*20

*10

Coins

Total Rs

Signature of the Depositor

Branch Stamp