Depositor Copy Branch Copy

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

Date: 21-07-2019 Branch Teller: Use SCR 008765 Deposit > Fee Collection > State Bank Collect
Date: 21-07-2019
Beneficiary/Remittance Details
Beneficiary/Remittance Details
State Bank Collect Reference No. DUB7187927
State Bank Collect Reference No. DUB7187927
INDIAN INSTITUTE OF TECHNOLOGY (B.H.U.),
Beneficiary: INDIAN INSTITUTE OF TECHNOLOGY (B.H.U.),
VARANASI Beneficiary:
VARANASI
Category: MESS CHARGE ADVANCE
Category: MESS CHARGE ADVANCE
Remitter Vinayak
Remitter Vinayak
Rs
Collection Amount 12,000.00 Rs
Comission 59.00 Collection Amount 12,000.00
Total (Rupees Twelve Thousand Fifty Nine Only) 12,059.00 Comission 59.00
Total (Rupees Twelve Thousand Fifty Nine Only) 12,059.00
Details of Cash / Cheques Rs p Mode of Payment (Choose Either Cash / Cheque)

Cash PAN:

Please quote your PAN for Cash remittance >= Rs. 50,000
Total Rs
Amount
Instructions for Depositor: This is not an e-receipt. After payment , please visit www.onlinesbi.com > 'State Bank Cash Notes Rs P
Collect' and click on the hyperlink at the bottom of the page to generate the e-receipt. *2000
*500
(To be Filled in by the Bank)
*200
Journal No: DUB7187927 *100
*50
*20
Branch Name: *10

Branch Code: Deposit Date:

Coins
Total Rs
Branch Stamp
Cheque
Cheque No: Cheque Date:
Authorised Signatory
Drawee Bank: State Bank of India (other bank cheques not accepted under PAP)
Branch:

Signature of the Depositor

Space for Bank use

Branch Stamp