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PoP P B R A.
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towards the service charges from the counter.
-P P
ACC Id
--P P T
1 to 100
101 to 5000
Above 5000
Stamp duty Amount/---P R
Application Date / Ai -P
/ 20
10
15
Nil
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---~ T / Phone
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PAN
PIN
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PAN
PIN
2 P-W-
2nd Party
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Type of payment
w.w.
D.D.
NEFT
--W-
Cash
RTGS
Cash Deposit
-W- g
Denomination
--P / Bank
-T /Branch
Bv T
Pay-order
Account to Account Transfer
DD/PO/UTR/REF No.
-./
1000 X
500 X
100 X
50 X
20 X
10 X
5 X
2 X
1 X
Total /--
The Information given in this form is to the best of my knowledge and is correct, complete and truly stated, I have read and understood the instructions
overleaf. I also acknowledge the receipt of stamp certificate. --- G --W- -W - qr-W --X---.
Name of the Party/Representative / --- -
Signature/
(For Office use only)
I verify that the Application Form is in order
To be filled by USER/ P- -
SUBIN
Signature/
---r W-- T
SHCIL e-Stamping
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Certificate Number
Signature/ --
--- / RECEIPT
--P R-
Stamp duty Amount
w.w./ Bv T / D.D. / Pay-order No.
IN
Type of payment
Cash
RTGS
D.D.
NEFT
1 P-W-
2- P-W-
1st Party
2nd Party
Pay-order
Account to Account Transfer
---P /Date
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