ACK Slip

http://www.recruitment.kar.nic.in/rdpr/AckSlip.aspx?RefNo=289402&&...

Zilla Panchayath, BAGALKOTE

Rural Development and Panchayath Raj Department

Government of Karnataka Acknowledgement Slip 289402 PANCHAYATH DEVELOPMENT OFFICER

Reference No Post applied for District opted for BAGALKOTE appointment Place of Examination BAGALKOTE Full Name( as in GIRIJA BIDARIMATH SSLC/10th Cert) Mother's Name SHANTA Father's Name CHANDRASHEKARAYYA Gender Female Date of Birth 19/01/1982 Applied Category 3B Do you come under KMS these groups? Are you in Govt. No Service? Do you claim age Not Applicable relaxation? Are you a Graduate? Yes C S BIDARIMATH, VIDYACHETAN , RAMDEV Address for GALLI, communication JAMKHANDI District BAGALKOTE PIN 587301 Email address girija.bidarimath@gmail.com Landline Phone No 221267 Mobile Phone No 9986158495 Medium of writing English test
I hereby declare that all contents made in this application are true, complete and correct to the best of my knowledge and belief. I have read the rules and understand that in the event of any information being found false or ineligibility being detected before or after the selection ,action can be taken against me by the Government under rule 20 of Karnataka Civil Services(General Recruitment) rules 1977 as amended from time to time. I have read the rules and instructions carefully and hereby undertake to abide by them. I further declare that, I fulfill all the eligibility conditions regarding age, education qualifications, reservations etc., wherever applicable,prescribed for the post. Place :BAGALKOTE Date :06/08/2009 Signature of the Candidate

1 of 2

10/7/2009 12:03 PM

ACK Slip

http://www.recruitment.kar.nic.in/rdpr/AckSlip.aspx?RefNo=289402&&...

LAST DATE OF CHALLAN PAYMENT AT BANK: 11.08.2009

Challan
Zilla Panchayath, BAGALKOTE Rural Development & Panchayat Raj Dept. Government Of Karnataka Candidate Copy Bank and Branch Name bank use only Bank Journal No Bank Journal Date Post Applied For District opted for appointment Ref No Name PANCHAYATH DEVELOPMENT OFFICER BAGALKOTE Post Applied For District opted for appointment Ref No Name Address Paid into A/C No Soudha, bank use only Bank Copy

Challan
Zilla Panchayath, BAGALKOTE Rural Development & Panchayat Raj Dept. Government Of Karnataka Bank and Branch Name Bank Journal No Bank Journal Date PANCHAYATH DEVELOPMENT OFFICER BAGALKOTE

289402

289402
GIRIJA BIDARIMATH C S BIDARIMATH, VIDYACHETAN , RAMDEV GALLI, JAMKHANDI,BAGALKOTE the Credit of Secretary RDPR 64044930154 , State Bank of Mysore , Vidhana B'lore Amount 500.00 500.00

GIRIJA BIDARIMATH C S BIDARIMATH, VIDYACHETAN , Address RAMDEV GALLI, JAMKHANDI,BAGALKOTE Paid into the Credit of Secretary RDPR A/C No 64044930154 , State Bank of Mysore , Vidhana Soudha , B'lore Sl No Particulars 1 Application Fee Total Amount in Words: Five hundred only Amount 500.00 500.00

Sl No Particulars 1 Application Fee Total Amount in Words: Five hundred only

Signature of Remitter/Applicant Received the above amount in Rs(in words) Five hundred only

Signature of Remitter/Applicant Received the above amount in Rs(in words) Five hundred only

Date :

Signature of Receiving authority

Date :

Signature of Receiving authority

Accepted at all the Branches of SBM. (In case of non availability of SBM then SBI or SBH) No bank charges to be collected from the remitter/applicant

Accepted at all the Branches of SBM. (In case of non availability of SBM then SBI or SBH) No bank charges to be collected from the remitter/applicant

Print

Back

2 of 2

10/7/2009 12:03 PM