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					 (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)
                                                                                                                               TO BE ENCLOSED WITH THE
PAY-IN-SLIP                          BANK’S COPY      PAY-IN-SLIP                 CANDIDATES’S COPY         PAY-IN-SLIP
                                                                                                                                      APPLICATION
                      KVPY – 2011                                           KVPY – 2011                                           KVPY – 2011
                      INDIAN INSTITUTE OF SCIENCE                           INDIAN INSTITUTE OF SCIENCE                           INDIAN INSTITUTE OF SCIENCE
                      BANGALORE – 560 012                                   BANGALORE – 560 012                                   BANGALORE – 560 012

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

Branch Name and Address:                              Branch Name and Address:                              Branch Name and Address:

Paid into the credit of Kishore Vaigyanik Protsahan   Paid into the credit of Kishore Vaigyanik Protsahan   Paid into the credit of Kishore Vaigyanik Protsahan
Yojana(KVPY)                                          Yojana(KVPY)                                          Yojana(KVPY)
                                                      SB A/C No. 10270577392                                SB A/C No. 10270577392
SB A/C No. 10270577392
                                                                                         Rs.                                                  Rs.
                                  Rs.                 Rupees…………………………                                      Rupees…………………………
Rupees…………………………

Application No.:                                      Application No.:                                      Application No.:
              ……………………………….                                         ……………………………….                                              ……………………………….
Name and      ……………………………….                           Name and      ……………………………….                           Name and           ……………………………….
address of    ……………………………….                           address of    ……………………………….                           address of         ……………………………….
the candidate ……………………………….                           the candidate ……………………………….                           the candidate      ……………………………….
              ……………………………….                                         ……………………………….                                              ……………………………….
              ………………Pin……………                                        ………………Pin……………                                             ………………Pin……………

Application Processing fee:                           Application Processing fee:                           Application Processing fee:
Tick as applicable                                    Tick as applicable                                    Tick as applicable
  General Category     SC/ST                          General Category       SC/ST                          General Category        SC/ST
(a) Rs. 200/- □        (a) Rs. 100/- □                (a) Rs. 200/- □        (a) Rs. 100/- □                (a) Rs. 200/- □         (a) Rs. 100/- □
(b) Bank charges if    (b) Bank charges if            (b) Bank charges if    (b) Bank charges if            (b) Bank charges if     (b) Bank charges if
any                    any                            any                    any                            any                     any
Signature of the                                      Signature of the                                      Signature of the
Depositor                                             Depositor                                             Depositor

Signature of the                                      Signature of the                                      Signature of the
Cashier                                               Cashier                                               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.

				
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posted:10/18/2011
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