FORM 1

FORM 1

BRANCH COPY

RGUHS COPY

RGUHS GENERAL ACCOUNT

RGUHS GENERAL ACCOUNT

SBM ACCOUNT NO. 54019480881

SBM ACCOUNT NO. 54019480881

IFSC CODE: SBMY0040012

IFSC CODE: SBMY0040012

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

Rajiv Gandhi University of Health

Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Rajiv Gandhi University of Health

Sciences, Karnataka.
Name of the Bank:
Branch Name

Name of the
College /Student:

State Bank of Mysore

Br.Code

Name of the
College /Student:

Address :

Address :
Pin :

Pin :

Phone :
Class

Name of the Course

Reg No.

Phone :
Class

I / II / III / IV Name of the Course

Subject

Reg No.

Separate Challans to be made for UG / PG/

SuperSpeciality/ Ph.d/ Fellowship
Particulars of Fee Remitted

Separate Challans to be made for UG / PG/ SuperSpeciality/

Ph.d/ Fellowship

Amount

Particulars of Fee Remitted

I. APPLICATION FEE (AFF / ADM/ OTHER)

I. APPLICATION FEE (AFF / ADM/ OTHER)

II. FEE - AFFILIATION

II. FEE - AFFILIATION

1.Fresh/Additional Course

1.Fresh/Additional Course

2.Renewal (continuation)

2.Renewal (continuation)

3.Annual Fee (continuation)

3.Annual Fee (continuation)

4.Administrative & Service Charges(cont)

4.Administrative & Service Charges(cont)

5.Increase in intake UG/PG

5.Increase in intake UG/PG

6.Compliance Report FeeLate fee/Penalty

6.Compliance Report Fee

7. Misc (Specify)

7. Misc (Specify)

III. FEE - ADMISSION

III. FEE - ADMISSION

1.Registration

1.Registration

2.Admission

2.Admission

3.Sports

3.Sports

4.Student Welfare Fund

4.Student Welfare Fund

5 Late Admission /Submission Fee

5 Late Admission /Submission Fee

6.Additional Examination Fee PG

6.Additional Examination Fee PG

IV. FEE - GENERAL

IV. FEE - GENERAL

1.Eligibility

1.Eligibility

2.Migration

2.Migration

3.NOC

3.NOC

4.Fee collected under RTI Act

4.Fee collected under RTI Act

5.Sale of Tender FORM

5.Sale of Tender FORM

6.Sale of old News Papers / Records

6.Sale of old News Papers / Records

7.EMD
8.Misc Fee (Specify)

7.EMD
8.Misc Fee (Specify)

Total

fee

Total

Amount (in words) Rupees

fee

Signature of the Remitter

NOTE:FEE ONCE PAID WILLNOT BE REFUNDED

Date:

Signature of the Remitter

FOR THE USE OF BANK ONLY

Amount (in words) Rupees

FOR THE USE OF BANK ONLY

Amount (in words) Rupees

Challan No./ UTR No.:

Challan No./ UTR No.:

Date &
Bank Seal

Amount

Amount (in words) Rupees

NOTE:FEE ONCE PAID WILLNOT BE REFUNDED

Date:

I / II / III / IV

Subject

Date &
Bank Seal

Signature of the Cashier

receiving the money
(To be retainedin the BRANCH )

Signature of the Cashier

receiving the money

(To be issued to the Remitter for submitting along with application to University

FORM 2

FORM 2

BRANCH COPY
RGUHS EXAMINATION ACCOUNT

RGUHS COPY
RGUHS EXAMINATION ACCOUNT

SBM ACCOUNT NO. 54019480870

SBM ACCOUNT NO. 54019480870

IFSC CODE: SBMY0040012

IFSC CODE: SBMY0040012

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Address :

Address :
Pin :

Pin :

Phone :
Class

Name of the Course

Reg No.

Subject

Class

Reg No.

Separate Challans to be made for UG / PG/

SuperSpeciality/ Ph.d/ Fellowship
Particulars of Fee Remitted

Phone :

I / II / III / IV Name of the Course

Separate Challans to be made for UG / PG/

SuperSpeciality/ Ph.d/ Fellowship

Amount

Particulars of Fee Remitted

01.Application

01.Application

02.Exam

02.Exam

03.Dissertation

03.Dissertation

04.Retotalling / Answer Script Xerox

04.Retotalling / Answer Script Xerox

05.Marks Card / Duplicate /Consolidate

05.Marks Card / Duplicate /Consolidate

06.Provisional Degree Certificate

06.Provisional Degree Certificate

07.Convocation / Rank Certificate

07.Convocation / Rank Certificate

08.Transcript / Attestation /Name Correction

08.Transcript / Attestation /Name Correction

09.Penalty

09.Penalty

10.Others (SpecifY)

10.Others (SpecifY)

Total

fee

Amount (in words) Rupees

I / II / III / IV

Subject

Total

Amount

fee

Amount (in words) Rupees

NOTE: FEE ONCE PAID WILL NOT BE REFUNDED

NOTE: FEE ONCE PAID WILL NOT BE REFUNDED
Date:

Signature of the Remitter

Date:

For the use of the Bank

Signature of the Remitter

For the use of the Bank

Amount (in words) Rupees

Amount (in words) Rupees

Challan No./ UTR No.:

Challan No./ UTR No.:

Date &
Bank Seal

Signature of the Cashier

receiving the money

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be retainedin the BRANCH )

(To be issued to the Remitter for submitting along with application

to University

FORM 3

FORM 3

BRANCH COPY

RGUHS COPY

RGUHS HELINET ACCOUNT

RGUHS HELINET ACCOUNT

SBM ACCOUNT NO.54019483532

SBM ACCOUNT NO.54019483532

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:

State Bank of Mysore

Branch Name
Name of the
College
/Student:
Address :

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:

State Bank of Mysore

Branch Name
Name of the
College
/Student:
Address :

Pin :

Pin :

Phone :

Name of the Course:

Class:

I / II / III / IV

Reg No.
Subject:

Phone :

Name of the Course:

Class:

I / II / III / IV

Reg No.
Subject:

Separate forms to be made for

UG/PG/SuperSpeciality/Ph.d/Fellowship
Particulars of fee Remitted

Amount

1.Digital Library Service Fee/PGDHL:

2.Helinet Institutional fee

Separate forms to be made for

UG/PG/SuperSpeciality/Ph.d/Fellowship
Particulars of fee Remitted
1.Digital Library Service Fee/PGDHL:

2.Helinet Institutional fee

3. Helinet Student Registration Fee

3. Helinet Student Registration Fee

4.Helinet-Student Fee:

4.Helinet-Student Fee:

5.Misc Fee (Specify)

5.Misc Fee (Specify)

Total

fee

Amount (in words) Rupees

NOTE: ONCE PAID WILL NOT BE REFUNDED

Date:

Signature of the Remitter

For the use of the Bank

Total

fee

Amount (in words) Rupees

NOTE: ONCE PAID WILL NOT BE REFUNDED

Date:

Signature of the Remitter

For the use of the Bank

Amount (in words) Rupees

Amount (in words) Rupees

Challan No./ UTR No.:

Challan No./ UTR No.:

Date &
Bank Seal

Amount

Signature of the Cashier

receiving the money

(To be retainedin the BRANCH )

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be issued to the Remitter for submitting along with application to

University)

FORM 4

FORM 4

BRANCH COPY

RGUHS COPY

RGUHS GENERAL ACCOUNT

RGUHS GENERAL ACCOUNT

SBM ACCOUNT NO. 54019530822

SBM ACCOUNT NO. 54019530822

IFSC CODE: SBMY0040012

IFSC CODE: SBMY0040012

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Address :

Address :
Pin :

Pin :

Phone :
Class

Name of the Course

Reg No.

Phone :
Class

I / II / III / IV Name of the Course

Subject

Reg No.

I / II / III / IV

Subject

Separate FORMs to be made for

UG/PG/SuperSpeciality/Ph.d/Fellowship

Separate FORMs to be made for

UG/PG/SuperSpeciality/Ph.d/Fellowship

Particulars of fee Remitted

Particulars of fee Remitted

Amount

01. NSS REGULAR

01. NSS REGULAR

02.MISC FEE (Specify)

02.MISC FEE (Specify)

Total

fee

Amount (in words) Rupees

Total

Signature of the Remitter

fee

Amount (in words) Rupees

NOTE: FEE ONCE PAID WILL NOT BE REFUNDED

Date:

NOTE: FEE ONCE PAID WILL NOT BE REFUNDED

Date:

For the use of the Bank

Signature of the Remitter

For the use of the Bank

Amount (in words) Rupees

Amount (in words) Rupees

Challan No./ UTR No.:

Challan No./ UTR No.:

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be retainedin the BRANCH )

Amount

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be issued to the Remitter for submitting along with application

to University

FORM-5

FORM-5

BRANCH COPY

RGUHS COPY

RGUHS GENERAL ACCOUNT

RGUHS GENERAL ACCOUNT

SBM ACCOUNT NO. 54019529374

SBM ACCOUNT NO. 54019529374

IFSC CODE: SBMY0040012

IFSC CODE: SBMY0040012

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

PAYABLE AT ALL BRANCHES OF STATE BANK OF MYSORE

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Rajiv Gandhi University of

Health Sciences, Karnataka.
Name of the Bank:
Branch Name

State Bank of Mysore

Br.Code

Name of the
College /Student:

Address :

Address :
Pin :

Pin :

Phone :
Class

Name of the Course

Reg No.

Subject

Class

Reg No.

Separate Challans to be made for UG / PG/

SuperSpeciality/ Ph.d/ Fellowship
Particulars of Fee Remitted

Phone :

I / II / III / IV Name of the Course

Amount

Separate Challans to be made for UG / PG/

SuperSpeciality/ Ph.d/ Fellowship
Particulars of Fee Remitted

01.P G E T Application

01.P G E T Application

02.P G E T Fee

02.P G E T Fee

03.P G E T Superspeciality

03.P G E T Superspeciality

04.Others (Specify)

04.Others (Specify)

Total fee
Amount (in words) Rupees

Total fee
Amount (in words) Rupees

Note:once paid will not be refunded

Date:

Signature of the Remitter

For the use of the Bank

I / II / III / IV

Subject

Amount

Note:once paid will not be refunded

Date:

Signature of the Remitter

For the use of the Bank

Amount (in words) Rupees .

....

Amount (in words) Rupees .

....

Challan No.

Challan No.

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be retainedin the BRANCH )

Date &
Bank Seal

Signature of the Cashier

receiving the money

(To be issued to the Remitter for submitting along with application

to University