Student/Applicant copy

Institution Copy

Bank's Copy

NIIT UNIVERSITY

NIIT UNIVERSITY

NIIT UNIVERSITY

NH-8, Delhi-Jaipur Highway, Neemrana

NH-8, Delhi-Jaipur Highway, Neemrana

NH-8, Delhi-Jaipur Highway, Neemrana

Branch Sol Id

Branch Sol Id

Name of Branch:

Name of Branch:

0 0 0 0 0 0 0 0 0 0 0

Name of Branch:

Date of Deposit:

Date of Deposit:

0 0 0 0 0 0

Date of Deposit:

0 0 0 0 0 0

PAN No. of Institution

D D M M Y Y
A A A T N 7 3 4 7 M

PAN No. of Institution

D D M M Y Y
A A A T N 7 3 4 7 M

PAN No. of Institution

D D M M Y Y
A A A T N 7 3 4 7 M
0 0 3 6 S L F E E C O L

Account to be credited

Branch Sol Id

0 0 3 6 S L F E E C O L

Account to be credited

0 0 0 0 0 0 0 0 0 0 0

0 0 3 6 S L F E E C O L

Account to be credited

1. Institution Name

: F C N I I T

1. Institution Name

: F C N I I T

1. Institution Name

: F C N I

2. Student Name

2. Student Name

0 0 0 0 0 0 0 0 0 0 0 0 0

2. Student Name

0 0 0 0 0 0 0 0 0 0 0 0 0

3. Enrollment No.

3. Enrollment No.

0 0 0 0 0 0 0 0 0 0 0 0 0

3. Enrollment No.

0 0 0 0 0 0 0 0 0 0 0 0 0

4. Class/ Semester/Year

4. Class/ Semester/Year

0 0 0 0 0 0

4. Class/ Semester/Year

0 0 0 0 0 0

5. Course / Programe

5. Course / Programe

0 0 0 0 0 0

5. Course / Programe

0 0 0 0 0 0

6. Amount

6. Amount

6. Amount

7. Amount in words

7. Amount in words

: 0

7. Amount in words

: 0

8. Cash Details:
Denomination

8. Cash Details:

Amount

I T

8. Cash Details:

Amount

Denomination

Amount

Denomination

1000 X

1000 X

1000 X

500 X

500 X

500 X

100 X

100 X

100 X

50 X

50 X

50 X

20 X

20 X

20 X

10 X

10 X

10 X

5X

5X

5X

Total

Total

9.Depositor Contact No.

9.Depositor Contact No.

Cheque / DD No.

Drawn On Bank

0 0 0 0 0 0 0 0 0 0
0

Cheque / DD No.

Payable At Branch:

Payable At Branch:

Transaction ID
(Mandatorily filled by
Bank Officials)

Transaction ID
(Mandatorily filled by
Bank Officials)

Signature/ Stamp
ICICI Bank Ltd

Total

Signature of Depositor

* must be drawn payable at the centre of deposit of the instrument i.e. outstation
instruments not acceptable

Signature/ Stamp
ICICI Bank Ltd

9.Depositor Contact No.

Drawn On Bank 0

0 0 0 0 0 0 0 0 0 0
0

Cheque / DD No.

Payable At Branch:

Drawn On Bank 0

Transaction ID
(Mandatorily filled by
Bank Officials)

Signature of Depositor

* must be drawn payable at the centre of deposit of the instrument i.e. outstation
instruments not acceptable

Signature/ Stamp
ICICI Bank Ltd

Signature of Depositor

* must be drawn payable at the centre of deposit of the instrument i.e. outstation
instruments not acceptable