(last date to remit the money – 09/09/2011) (last date to remit the money – 09/09/2011) (last date to remit the money – 09/09/2011)

PAY-IN-SLIP BANK’S COPY

PAY-IN-SLIP CANDIDATES’S COPY PAY-IN-SLIP TO BE ENCLOSED WITH THE

APPLICATION

State Bank of India Payable at all Branches of SBI in India

Branch Name and Address:

Paid into the credit of Kishore Vaigyanik Protsahan

Yojana(KVPY)

SB A/C No. 10270577392

Rupees…………………………

State Bank of India Payable at all Branches of SBI in India

Branch Name and Address:

Paid into the credit of Kishore Vaigyanik Protsahan

Yojana(KVPY)

SB A/C No. 10270577392

Rupees…………………………

State Bank of India Payable at all Branches of SBI in India

Branch Name and Address:

Paid into the credit of Kishore Vaigyanik Protsahan

Yojana(KVPY)

SB A/C No. 10270577392

Rupees…………………………

Application No.: Application No.: Application No.:

Name and

address of

the candidate

……………………………….

……………………………….

……………………………….

……………………………….

……………………………….

………………Pin……………

Name and

address of

the candidate

……………………………….

……………………………….

……………………………….

……………………………….

……………………………….

………………Pin……………

Name and

address of

the candidate

……………………………….

……………………………….

……………………………….

……………………………….

……………………………….

………………Pin……………

Application Processing fee:

Tick as applicable

Application Processing fee:

Tick as applicable

Application Processing fee:

Tick as applicable

General Category SC/ST General Category SC/ST General Category SC/ST

(a) Rs. 200/- □

(b) Bank charges if

any

(a) Rs. 100/- □

(b) Bank charges if

any

(a) Rs. 200/- □

(b) Bank charges if

any

(a) Rs. 100/- □

(b) Bank charges if

any

(a) Rs. 200/- □

(b) Bank charges if

any

(a) Rs. 100/- □

(b) Bank charges if

any

Signature of the

Depositor

Signature of the

Depositor

Signature of the

Depositor

Signature of the

Cashier

Signature of the

Cashier

Signature of the

Cashier

Bank Stamp with date Bank Stamp with date Bank Stamp with date

*Girl/Physically/Visually challenged students are exempted from payment of processing fee.

KVPY – 2011

INDIAN INSTITUTE OF SCIENCE

BANGALORE – 560 012

KVPY – 2011

INDIAN INSTITUTE OF SCIENCE

BANGALORE – 560 012

KVPY – 2011

INDIAN INSTITUTE OF SCIENCE

BANGALORE – 560 012

Rs. Rs. Rs.