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					                        FORM-1                                                                  FORM-1                                                                  FORM-1
                      BANK COPY                                                               BANK COPY                                                                BANK COPY
                NIUM CURRENT ACCOUNT                                                    NIUM CURRENT ACCOUNT                                                    NIUM CURRENT ACCOUNT
             SBI ACCOUNT NO.30095385134                                              SBI ACCOUNT NO.30095385134                                              SBI ACCOUNT NO.30095385134
                 IFS CODE: SBIN0009047                                                   IFS CODE: SBIN0009047                                                   IFS CODE: SBIN0009047
    PAYABLE AT ALL BRANCHES OF STATE BANK OF INDIA                          PAYABLE AT ALL BRANCHES OF STATE BANK OF INDIA                          PAYABLE AT ALL BRANCHES OF STATE BANK OF INDIA
                   NATIONAL INSTITUTE OF UNANI                                             NATIONAL INSTITUTE OF UNANI                                             NATIONAL INSTITUTE OF UNANI
                            MEDICINE                                                                MEDICINE                                                                MEDICINE

Name of the Bank:           State Bank of India                         Name of the Bank:           State Bank of India                         Name of the Bank:           State Bank of India
Branch Name                                                             Branch Name                                                             Branch Name
    Student name:                                                           Student name:                                                           Student name:
              Address :                                                               Address :                                                               Address :




                    Pin :               Phone :                                             Pin :               Phone :                                             Pin :               Phone :
Name of the Course:                                                     Name of the Course:                                                     Name of the Course:

Category                                                                Category                                                                Category

                    Post Graduate Entrance Test Fee                                         Post Graduate Entrance Test Fee                                         Post Graduate Entrance Test Fee

           Particulars of fee Remitted                   Amount                    Particulars of fee Remitted                   Amount                    Particulars of fee Remitted                   Amount
General                                                                 General                                                                 General
OBC (not belonging to creamy layer)                                     OBC (not belonging to creamy layer)                                     OBC (not belonging to creamy layer)
PH                                                                      PH                                                                      PH
GOI / In-Service                                                        GOI / In-Service                                                        GOI / In-Service
SC/ST                                                                   SC/ST                                                                   SC/ST

                   Total      fee                                                          Total      fee                                                          Total      fee
Amount (in words) Rupees                                                Amount (in words) Rupees                                                Amount (in words) Rupees

              Note: Amount once paid will not be refunded                             Note: Amount once paid will not be refunded                             Note: Amount once paid will not be refunded


Date:                        Signature of the Remitter                  Date:                        Signature of the Remitter                  Date:                        Signature of the Remitter
                            For the use of the Bank                                                 For the use of the Bank                                                 For the use of the Bank


Amount (in words) Rupees ………………………….                                    Amount (in words) Rupees ………………………….                                    Amount (in words) Rupees ………………………….
…………………………………………………………………………                                            …………………………………………………………………………                                            …………………………………………………………………………
…………………………………………………....                                                 …………………………………………………....                                                 …………………………………………………....




Challan No.                                                             Challan No.                                                             Challan No.



 Date &                                                                   Date &                                                                  Date &
Bank Seal                   Signature of the Cashier receiving the money Bank Seal                  Signature of the Cashier receiving the money Bank Seal                  Signature of the Cashier receiving the money

				
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posted:10/13/2011
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