Branch Sol Id :

Name of branch :
Date of Deposit :
D D / M M / Y Y
Account to be credited
Denomination AMOUNT
1000 X
500 X
100 X
50 X
20 X
10 X
5 X
Total
9.Depositor Contact No.
Transaction ID
(Mandatorily filled by
Bank Officials)
Cheque / Payorder / DD No. Drawn On Bank
Payable At Branch:
Signature/ Stamp Signature of Depositor
ICICI Bank Ltd
* must be drawn payable at the centre of deposit of the instrument i.e. outstation instruments not
acceptable
Admission Form
Registration Fee
Dev. Fee (one time)
School Fee (Qtr 1/2/3/4)
Security Dep. (One time)
Text Book & Stationary
Transport Fee
Late Fee
PARTICULARS Amount
Student/Applicant copy
OTHERS
TOTAL
KALINGA INSTITUTE OF MINING ENGINEERING AND TECHNOLOGY
Chendipada, Angul, Odisha
1. Institution Name :
2. Student Name :
3. Roll No./Student Id :
4. Students Date of Birth :
5. Name of Father :
6. Class :
7. Section :
8. Month :
9. Amount in words :
10. Cash Details :
Branch Sol Id
Name of branch:
Date of Deposit:
D D / M M / Y Y
Account to be credited
Denomination AMOUNT
1000 X
500 X
100 X
50 X
20 X
10 X
5 X
Total
9.Depositor Contact No.
Transaction ID
(Mandatorily filled by
Bank Officials)
Cheque / Payorder / DD No. Drawn On Bank
Payable At Branch:
Signature/ Stamp Signature of Depositor
ICICI Bank Ltd
* must be drawn payable at the centre of deposit of the instrument i.e. outstation instruments not
acceptable
Admission Form
Registration Fee
Dev. Fee (one time)
School Fee (Qtr 1/2/3/4)
Security Dep. (One time)
Text Book & Stationary
Transport Fee
Late Fee
PARTICULARS Amount
Institutes copy
OTHERS
TOTAL
KALINGA INSTITUTE OF MINING ENGINEERING AND TECHNOLOGY
Chendipada, Angul, Odisha
1. Institution Name :
2. Student Name :
3. Roll No./Student Id :
4. Students Date of Birth :
5. Name of Father :
6. Class :
7. Section :
8. Month :
9. Amount in words :
10. Cash Details :
Branch Sol Id
Name of branch:
Date of Deposit:
D D / M M / Y Y
Account to be credited
Denomination AMOUNT
1000 X
500 X
100 X
50 X
20 X
10 X
5 X
Total
9.Depositor Contact No.
Transaction ID
(Mandatorily filled by
Bank Officials)
Cheque / Payorder / DD No. Drawn On Bank
Payable At Branch:
Signature/ Stamp Signature of Depositor
ICICI Bank Ltd
* must be drawn payable at the centre of deposit of the instrument i.e. outstation instruments not
acceptable
Admission Form
Registration Fee
Dev. Fee (one time)
School Fee (Qtr 1/2/3/4)
Security Dep. (One time)
Text Book & Stationary
Transport Fee
Late Fee
PARTICULARS Amount
Banks copy
OTHERS
TOTAL
KALINGA INSTITUTE OF MINING ENGINEERING AND TECHNOLOGY
Chendipada, Angul, Odisha
1. Institution Name :
2. Student Name :
3. Roll No./Student Id :
4. Students Date of Birth :
5. Name of Father :
6. Class :
7. Section :
8. Month :
9. Amount in words :
10. Cash Details :
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