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BANK COPY TISS COPY STUDENT COPY

Date:____/___/20___ Bank Journal No. _________ Date:____/___/20___ Bank Journal No._________ Date:____/___/20___ Bank Journal No. _________

TATA INSTITUTE OF SOCIAL SCIENCES TATA INSTITUTE OF SOCIAL SCIENCES TATA INSTITUTE OF SOCIAL SCIENCES
MUMBAI – 400 088 MUMBAI – 400 088 MUMBAI – 400 088
STATE BANK OF INDIA (Deonar Branch) STATE BANK OF INDIA (Deonar Branch) STATE BANK OF INDIA (Deonar Branch)
Branch Code 3109 Branch Code 3109 Branch Code 3109
TISS — Fees A/c 31134925071 TISS — Fees A/c 31134925071 TISS — Fees A/c 31134925071

Student Name: ______________________________ Student Name: ______________________________ Student Name: ______________________________

Enrol. No./Reg. No.__________ Sem. No. I / II / III / IV Enrol. No./Reg. No. _________ Sem. No. I / II / III / IV Enrol. No./Reg. No. __________Sem. No. I / II / III / IV

Programme: ________________________________ Programme: ________________________________ Programme:_________________________________

Sl. Particulars Amount Sl. Particulars Amount Sl. Particulars Amount


No. Rs. No. Rs. No. Rs.
1. Fees 1. Fees 1. Fees
2. Insurance 2. Insurance 2. Insurance
3. Development Fee 3. Development Fee 3. Development Fee
4. Study Tour/Rural Camp 4. Study Tour/Rural Camp 4. Study Tour/Rural Camp
5. Deposits 5. Deposits 5. Deposits
6. Hostel Charges 6. Hostel Charges 6. Hostel Charges
7. Dining Hall Advance 7. Dining Hall Advance 7. Dining Hall Advance
8. 8. 8.
9. 9. 9.
10. 10. 10.
Total Rs. Total Rs. Total Rs.
Note: Additional Bank Charges Rs. 50/- Note: Additional Bank Charges Rs. 50/- Note: Additional Bank Charges Rs. 50/-

Amount in Words (Rupees _____________________ Amount in Words (Rupees ____________________ Amount in Words (Rupees _____________________

_________________________________________ ) __________________________________________) _________________________________________ )

__________________ _____________________ ___________________ ____________________ __________________ _____________________


Student’s Signature Bank Seal with Student’s Signature Bank Seal with Student’s Signature Bank Seal with
Signature Signature Signature