CAUTION : USE PAYFEE MENU :OPTION IN FINACLE INSTEAD entry in *Important Note (for Bank Official) Use PAYFEE

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`Devotee Copy

Punjab National Bank

Branch Institute Name Institute ID NIRMAL DARBAR NIRDA Date of Deposit DETAILS OF THE DEVOTEE Devotee Name SMG PUJA DONAT Course Code Fee * (City of Smagam) Code Cash Deposit: Denomination Rs. Ps

Bank Copy
DIST. NO.

Punjab National Bank

Branch Institute Name Institute ID NIRMAL DARBAR NIRDA Date of Deposit

DIST. NO.

DD MM YY Roll/Mobile No.

APONT

PHAPN

DASND

PURAN

GRPAP

CD

PHOTO

DD MM YY DETAILS OF THE DEVOTEE Roll/Mobile No. Devotee Name DONAT APONT PHAPN DASND PURAN GRPAP CD PHOTO Course SMG PUJA Code Fee (City of Code* Smagam) Cash Deposit: Cheque/DD Deposit: Date of Chq/DD No Chq/DD Name of Bank PNB

Cheque/DD Deposit: Date of Chq/DD No Chq/DD

Denomination Name of Bank PNB Rs. Ps

Rs.

Ps

Rs.

Ps

1000 * 500 * 100 * 50 * 20 * Total fee payable Rs. 10 * Commission Rs. 0 0 - 0 0 5* Total amount Rs. Coins * Total Amount (in words): Rs. ______________________________________________________ __________________________________________________________________________ Name of the Depositor Signature Address for communication Phone No. For Bank use only Acknowledgement Cashier/Officer

1000 * 500 * 100 * 50 * 20 * Total fee payable Rs. 10 * Commission Rs. 0 0 - 0 0 5* Total amount Rs. Coins * Total Amount (in words): Rs. ______________________________________________________ __________________________________________________________________________ Name of the Depositor Signature Address for communication Phone No. For Bank use only Acknowledgement Cashier/Officer

INSTITUTE ID CHARGES

NIRDA Rs.00/- per transaction for collection of fee Course Name Course Code SMG PUJA DONAT APONT DASND PURAN GRPAP CD PHOTO FEE CODE

Instructions
1) Mention Pay Fee category at the Bank. 2) Fill both Bank copy and Devotee Copy. 3)VERY IMPORTANT: Mobile Number, Name of Devotee & City of Samagam must be entered. 4) Checks or Demand Drafts should be made in the name of "Nirmal Darbar". 5) Demand Draft should be made payable at "Punjab National Bank(Any Branch)". 6) After Deposit is complete, send the devotee copy of this form by courier to :
Nirmal Darbar 1412A Chiranjiv Tower 43 Nehru Place New Delhi, ND 110019 Ph: 011-40766400

COURSE CODES

SAMAGAM PUJA DONATION APPOINTMENT DASWAND PURANMASHI GROUP APPOINTMENT CD PHOTO FEE CODES CITY OF SAMAGAM DELHI AHMEDABAD SURAT BARODA GOA BHUBNESHWAR UDAIPUR HYDERABAD BANGLORE MUMBAI PUNE RAIPUR NAGPUR LUCKNOW KANPUR INDORE PATNA JAIPUR CHENNAI CHANDIGARH LUDHIANA PATIALA SOLAN SHIMLA MANDI BHOPAL JULLUNDER PATHANKOT KULU JAMMU

DELHI AHMED SURAT BAROD GOA BHUBN UDAIP HYDER BANGL MUMBA PUNE RAIPU NAGPU LUCKN KANPU INDOR PATNA JAIPU CHENN CHAND LUDHI PATIA SOLAN SHIML MANDI BHOPA JULLU PATHA KULU JAMMU

Description of each Item on the form Branch: Enter the name of PNB Branch. Institute Name: "NIRMAL DARBAR" (Already filled for you) Institute Id: NIRDA (Already filled) Date of Deposit: Enter date of deposit in DD MM YY format Details of Devotee
Roll/Mobile No. : Mobile number of Devotee*

Devotee Name: Name of Devotee Course Code: The purpose for which this deposit is being made. List of Codes and their purpose are mentioned on this page. Enter Course Code of corresponding Course Name. Fee Code(City of Samagam)*: City of Samagam, which you are registering. List of Station(Fee codes) are given below. You can leave it blank if payment is not for Samagam. Cash Deposit: Fill in the details if depositing cash. Check/DD deposit: Fill in details if payment is by Check or Demand Draft Total Fee Payable: Enter Total amount Commission: This amount is 0 Rs/-. Not Applicable for devotees. Total Amount*: Same as Total Fee Payable. Amount in Words: Write the total amount in words. Name of Depositor*: Write full name of depositor Signature: Sign in this section Address for Communication: Enter your postal address. Phone No*: Enter your mobile phone number. *These fields must be entered. (FIELDS

HIGLIGHTED IN RED ARE COMPULSORY TO FILL)