(Candidate Copy)

(Bank Copy)

JEE(Main)-2014

JEE(Main)-2014

Cash can be deposited at any CBS Branch of ICICI Bank Bank A/C No. : Application No.: Name : Date of Birth : Category : Person with Disability (PwD) : Course : Mobile No. : Fee Rs : Printed on : JEE(Main)-2014 Fee A/C

Cash can be deposited at any CBS Branch of ICICI Bank Bank A/C No. : Application No.: Name : Date of Birth : Category : Person with Disability (PwD) : Course : Mobile No. : Fee Rs : Printed on : JEE(Main)-2014 Fee A/C

40007573
VALECHA TUSHAR SURESH
27/10/1996 GENERAL NO JEE(Main) Paper - 1 (B.E./B.Tech.) Only 7208355446 1000/15-11-2013 05:36:52 PM

40007573
VALECHA TUSHAR SURESH
27/10/1996 GENERAL NO JEE(Main) Paper - 1 (B.E./B.Tech.) Only 7208355446 1000/15-11-2013 05:36:52 PM

Signature of the Depositor

---(To be filled by the bank) Branch Name: Branch Code: Transaction Id: Deposit Date: _________/_________/2013

Signature of the Depositor Instructions for ICICI Bank Branches 1. This is an I Sure Pay Challan & Inst Code/ Account No. not required 2. Type "HCOREFEE" in finacle --> Select "JEE(Main)-2014 CBSE" --> Enter "Application No.:" -> Click Submit --> Verify Details --> Accept Cash --> Click Submit -->Generate Receipt --> Handover to Depositor. (To be filled by the bank) Branch Name: Branch Code: Transaction Id: Deposit Date: _________/_________/2013

Authorized Signatory

Authorized Signatory

Branch Stamp Candidate should revisit the website to download Acknowledgement Page after depositing the fee.

Branch Stamp Bank official is requested to enter Application No. and Name of candidate only in narrative column.