ORIGINAL DUPLICATE TRIPLICATE QUADRUPLICATE

ANDHRA PRADESH STATE COUNCIL OF ANDHRA PRADESH STATE COUNCIL OF ANDHRA PRADESH STATE COUNCIL OF ANDHRA PRADESH STATE COUNCIL OF
HIGHER EDUCATION HIGHER EDUCATION HIGHER EDUCATION HIGHER EDUCATION
EAMCET-2009 (ADMISSIONS) EAMCET-2009 (ADMISSIONS) EAMCET-2009 (ADMISSIONS) EAMCET-2009 (ADMISSIONS)
ANDHRA BANK – ANDB0000533 ANDHRA BANK – ANDB0000533 ANDHRA BANK – ANDB0000533 ANDHRA BANK – ANDB0000533

Bank authorities please enter HTNO & Bank authorities please enter HTNO & Bank authorities please enter HTNO & Bank authorities please enter HTNO &
Rank while entering in the system Rank while entering in the system Rank while entering in the system Rank while entering in the system

Account.No. 053310100002759 Account.No 053310100002759 Account.No 053310100002759 Account.No. 053310100002759

Date:-……………… Date:-……………….. Date:-……………….. Date:-………………..

Name: ………..…………………………. Name: ………..…………………………….. Name: ………..…………………………….. Name: ………..……………………………..

Registration Number…………………….. Registration Number ………………………… Registration Number …………………….. Registration Number ………………………

Hall Ticket Number……………………… Hall Ticket Number……………………….… Hall Ticket Number………………………. Hall Ticket Number…………………………

Rank……………………………………… Rank………………………………………… Rank………………………………………… Rank…………………………………………

The following amount is paid with The following amount is paid with regard The following amount is paid with The following amount is paid with
regard to my admission to my admission regard to my admission regard to my admission
Tuition/Counseling fee…………………… Tuition/Counseling fee…………………………. Tuition/Counseling fee…………………… Tuition /Counseling fee……………………

Total……………………………………… Total………………………………………… Total………………………………………… Total…………………………………………

(In words Rupees…………………………… (In words Rupees……………………………… (In words Rupees…………………………… (In words Rupees……………………………
………………………..) ……………………..) ………………………..) ………………………..)

Signature of Payee Signature of Payee Signature of Payee Signature of Payee

Seal of Bank in Seal of Bank in Seal of Bank in Seal of Bank in

Receipt of Amount Receipt of Amount Receipt of Amount Receipt of Amount
Scroll. No. Scroll. No. Scroll. No. Scroll. No.
BANKER’S COPY CONVENER COPY COLLEGE COPY CANDIDATE COPY