Aditya
Aditya
ICA - Shibpur
Student Copy
ICA - Shibpur
Center Copy
Date of Deposit
D M M
Bank Copy
Date of Deposit
D
Date of Deposit
D M M
D M M
Account to be credited
Account to be credited
Account to be credited
0 0 3 6 S L F E E C O L
0 0 3 6 S L F E E C O L
0 0 3 6 S L F E E C O L
1. Institution Name
: FCICAT
1. Institution Name
: FCICAT
1. Institution Name
: FCICAT
2. Student Name
2. Student Name
2. Student Name
3. Roll no
: 00228777
3. Roll no
: 00228777
3. Roll no
: 00228777
4. Class
: R0001
4. Class
: R0001
4. Class
: R0001
5. Course
: CIA01
5. Course
: CIA01
5. Course
: CIA01
6. Amount
: 2900.00
6. Amount
: 2900.00
6. Amount
: 2900.00
7. Amount in words
7. Amount in words
7. Amount in words
8. Cash Details
Denomination
8. Cash Details
Amount
Denomination
8. Cash Details
Amount
Denomination
1000 x
1000 x
1000 x
500 x
500 x
500 x
100 x
100 x
100 x
50 x
50 x
50 x
20 x
20 x
20 x
10 x
10 x
10 x
5x
5x
5x
Coins
Coins
Coins
Total
Total
Total
Amount
Cheque / DD No.
....................................................................
Cheque / DD No.
....................................................................
Cheque / DD No.
....................................................................
Drawn On Bank
....................................................................
Drawn On Bank
....................................................................
Drawn On Bank
....................................................................
Signature / Stamp
ICICI Bank Ltd.
Signature / Stamp
ICICI Bank Ltd.
Signature / Stamp
ICICI Bank Ltd.
Signature of Depositor
Signature of Depositor
Signature of Depositor