CHALLAN FORM (CASH VOUCHER) CHALLAN FORM (CASH VOUCHER)

BRANCH COPY CANDIDATE’S COPY

PUNJAB NATIONAL BANK- 01 PUNJAB NATIONAL BANK- 01
Application Fee Details Application Fee Details Affix Pass port
Recruitment of Officer Junior Management (Scale-I) Recruitment of Officer Junior Management (Scale-I) size Photograph
in Haryana Gramin Bank in Haryana Gramin Bank
(Branches to make entry using Pay Fee Menu Option Instead of TM)
Account No : 0838000104584726-HGBRECTPRJT2011
at PNB Civil Lines Rohtak Branch (code - 0838) Account No : 0838000104584726-HGBRECTPRJT2011
Institute ID : HGBRO at PNB Civil Lines Rohtak Branch (code - 0838)
Candidate’s Name : Mr./Mrs/Kum. ……………………………… Institute ID : HGBRO
Category* : SC/ST/PWD Rs.50/-+Rs.25/-** (Only
Candidate’s Name : Mr./Mrs/Kum………………………………
Postage) Category* SC/ST/PWD Rs.50/-+Rs.25/-** (Only
OBC/GEN/EXS Rs.500/-+Rs.25/-** Postage)
(Application fee & Postage) OBC/GEN/EXS Rs.500/-+Rs.25/-**
Fee Code : (Application fee & Postage)
Date of Birth :
Date of Birth :
PNB Branch Name :
PNB Branch Name :
Branch Code No# :
Branch Code No# :
Transaction ID # :
Transaction ID # :
Deposit Date :
Deposit Date :
Amount Rs. .......................
Application Fee/Postage Rs. ....................... (Rupees..........................................................................................only)

(Rupees..........................................................................................only)
Signature of Depositor Authorized Signatory
Address:.................... Stamp
Signature of Depositor Authorized Signatory ...................................
Address:.................... Stamp Phone/Mob. No.
................................... * Tick whichever is applicable.
Phone/Mob. No. (Make entry in Merit Rank Option of payee) ** Inter core transaction charges.
* Tick whichever is applicable. # Fee receiving branch is advised to write the Transaction ID and Branch
** Inter core transaction charges. Code No. above invariably.
# Fee receiving branch is advised to write the Transaction ID and (This part of the challan will be required to be submitted by the candidate at the time of
written test along with a photograph, otherwise the candidate will not be allowed to appear
Branch Code No. above invariably. at the examination.)
(Branches to make entry using Pay Fee Menu Option Instead of TM) (Branches to make entry using Pay Fee Menu Option Instead of TM)