Depositor Copy Branch Copy

Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch Date: 21-07-2016 Pre Acknowledgement Payment(PAP) Form for Payment through any SBI Branch

Beneficiary/Remittance Details Branch Teller: Use SCR 008765 Deposit > Fee Collection > State Bank Collect
State Bank Collect Reference No. DU51974701 Date: 21-07-2016

Beneficiary: COMPTROLLER, TNAU, COIMBATORE Beneficiary/Remittance Details

Category: Degree Certificate State Bank Collect Reference No. DU51974701
Last Date of Payment: 30-09-2024 01:00 Beneficiary: COMPTROLLER, TNAU, COIMBATORE
Remitter S PUGALENTHI Category: Degree Certificate
Rs Last Date of Payment: 30-09-2024 01:00
Collection Amount 1,800.00 Remitter S PUGALENTHI
Comission 58.00 Rs
Total (Rupees One Thousand Eight Hundred Fifty Eight Only) 1,858.00 Collection Amount 1,800.00
Comission 58.00
Details of Cash / Cheques Rs p
Total (Rupees One Thousand Eight Hundred Fifty Eight Only) 1,858.00
Mode of Payment (Choose Either Cash / Cheque)

Total Rs Cash PAN:

Please quote your PAN for Cash remittance >= Rs. 50,000
Instructions for Depositor: This is not an e-receipt. After payment , please visit www.onlinesbi.com > 'State Bank
Collect' and click on the hyperlink at the bottom of the page to generate the e-receipt. Amount
Cash Notes Rs P
*1000
(To be Filled in by the Bank)
*500
Journal No: DU51974701 *100
*50
*20
Branch Name:
*10
Branch Code: Deposit Date:
Coins
Branch Stamp Total Rs

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

Signature of the Depositor

Space for Bank use

Branch Stamp