Accounts Copy Student Copy Bank Copy

STATE BANK OF INDIA STATE BANK OF INDIA STATE BANK OF INDIA

Application Fee for Admission at Application Fee for Admission at Application Fee for Admission at
Indian Institute of Technology–Hyderabad Indian Institute of Technology–Hyderabad Indian Institute of Technology–Hyderabad
(SBI,IIT Code:14182) (SBI,IIT Code:14182) (SBI,IIT Code:14182)
(To be filled by the candidate) (To be filled by the candidate) (To be filled by the candidate)

Candidate’s Name: Mr. /Ms. _________________________________ Candidate’s Name: Mr. /Ms. _________________________________ Candidate’s Name: Mr. /Ms. _________________________________
_____________________&Dept., _____________________________ _____________________&Dept., _____________________________ _____________________&Dept., _____________________________

Account No. : 31454670693 (Power Jyoti A/c) Account No. : 31454670693 (Power Jyoti A/c) Account No. : 31454670693 (Power Jyoti A/c)
Application Fees for Online application (Tick whichever is applicable) Application Fees for Online application (Tick whichever is applicable) Application Fees for Online application (Tick whichever is applicable)
General General General
SC SC SC
/ OBC Amount / OBC Amount / OBC Amount
Name of Programme / Name of Programme / Name of Programme /
& (Rs.) & (Rs.) & (Rs.)
ST ST ST
Others Others Others
M.Tech M.Tech M.Tech
Bank Commission 25/- Bank Commission 25/- Bank Commission 25/-
Total Total Total

Cash/Cheque No……………..... Dt…./……/…………Bank …………………….. Cash/Cheque No……………..... Dt…./……/…………Bank …………………….. Cash/Cheque No……………..... Dt…./……/…………Bank ……………………..
(Inwords  ………………………………………………………………………………… (Inwords  ………………………………………………………………………………… (Inwords  …………………………………………………………………………………

Signature of Depositor Authorized Signatory Signature of Depositor Authorized Signatory Signature of Depositor Authorized Signatory
with stamp with stamp with stamp
(To be filled by the Bank) (To be filled by the Bank) (To be filled by the Bank)
Fee receiving branch is advised to write the Deposit Journal No. and 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. Branch code no above invariably.

SBI Branch Name & Code No. : SBI Branch Name & Code No. : SBI Branch Name & Code No. :

Unique ID/ Journal No. : Unique ID/ Journal No. : Unique ID/ Journal No. :
(7 to 10 digits) (7 to 10 digits) (7 to 10 digits)
Deposit Date : Deposit Date : Deposit Date :

Authorized Signatory Authorized Signatory Authorized Signatory

with stamp with stamp with stamp

For any assistance please contact on For any assistance please contact on For any assistance please contact on
(M) 8008504951 (O) 040-2301 6088 (M) 8008504951 (O) 040-2301 6088 (M) 8008504951 (O) 040-2301 6088