PAYMENT DETAIL FORM - ACADEMIC YEAR 2019-20

To be submitted to Fees Department

Date ........................... SR.NO: –

A) Student Details (To be filled in by parent)

Student Name
App./Enr.No Board : Grade : Division :
B) Payment Details (To be filled in by parent)
Sr. No. Cheque/DD Dated Cheque No. Bank Name Branch Amount (Rs.)
1
2 01-Jul-2019
3 01-Oct-2019
4 01-Jan-2020
TOTAL
 Mode of Payment: - CTS-2010 compliant Cheque/DD.
 Cheque/DD should be made in favour of “VIBGYOR HIGH NIBM ”
 It is compulsory to write the Students Name, Board, Grade and App./Enr. No. behind every Cheque/PDC/DD.
C) Signature

Name____________________________________________________ PAN No.______________________________________

Signature _____________________________ Relationship with student Mother Father Guardian

For official use only

Data entered in the system by: Name …………………………............................ Sign.……………………….. Date ………………….....

Data checked by: Name ……………………………............................. Sign.……………………….. Date ………….....………

PAYMENT DETAIL FORM - ACADEMIC YEAR 2019-20

PARENT ACKNOWLEDGEMENT COPY

SR.NO: –
A) Student Details (To be filled in by parent)

Student Name :
App./Enr.No Board : Grade : Division :
B) Payment Details (To be filled in by parent)
Sr. No. Cheque/DD Dated Cheque No. Bank Name Branch Amount (Rs.)
1
2 01-Jul-2019
3 01-Oct-2019
4 01-Jan-2020
TOTAL

Date: ................ Authorised Signatory: ................................

RUBBER
NOTE: This is only an acknowledgement. An official fee receipt will be handed over separately.
STAMP
Kindly retain this acknowledgement and produce it for collection of school essentials.