B Pharm Challan 70663m

(Challan for KSPC Online Registration ) www.sbtonline.in REGISTRANT’S COPY

Branch :

(Challan for KSPC Online Registration ) www.sbtonline.in KSPC COPY

(Challan for KSPC Online Registration ) www.sbtonline.in

BANK COPY

PAY IN SLIP

PAY IN SLIP

PAY IN SLIP

State Bank of Travancore

State Bank of Travancore

State Bank of Travancore

Date

20

Branch :

Date

20

Branch :

Date

Name : Kerala State Pharmacy Council

Name : Kerala State Pharmacy Council

Name : Kerala State Pharmacy Council

No.

No.

No.

:

TVM Main Branch (000028) DENO

Registrant’s Name and Address

Branch

PIECES

Amount Rs

Ps

1000 x

: 67335018932 :

TVM Main Branch (000028) DENO

Registrant’s Name and Address

Signature of Depositor

CASH DEPOSIT

CASH DEPOSIT

Tel / Mob

20

x

10

x

5

x

Amount Rs

Ps

: 67335018932 :

Tel / Mob

coin

Signature of Depositor

Total

100 x 50

x

20

x

10

x

5

x

Tel / Mob

coin

Signature of Depositor

Total

Rupees( in words)

For office use only

For office use only

For office use only

Authorised Signatory

TRAN.ID

Cashier

PIECES

Amount Rs

Ps

1000 x 500 x

Rupees( in words)

Cashier

DENO

Registrant’s Name and Address

Rupees( in words)

TRAN.ID

TVM Main Branch (000028)

500 x

100 x x

PIECES

1000 x

500 x 50

Branch

CASH DEPOSIT

Branch

: 67335018932

20

Authorised Signatory

TRAN.ID

100 x 50

x

20

x

10

x

5

x

coin Total

Cashier

Authorised Signatory