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<tr><td align="right">ORIGINAL</td></tr>
<tr><td align="center"><b>Department of Technical Educat
ion</b></td></tr>
<tr><td align="center">Govt. of Andhra Pradesh</td></tr>
<tr><td align="center"><h3>POLYCET - 2013 (ADMISSIONS)</
h3></td></tr>
<tr><td align="center">ANDHRA BANK - ANDB0000533</td></
tr>
<tr><td style=" border-width:thin; border-style:dotted;
border-color:Teal" align="center">Account.No. 053310100036127</td></tr>
<tr><td align="center">Bank authorities to please <br /
>enter Hall Ticket Number </td></tr>
<tr><td align="right">Date : ______________</td></tr>
<tr><td align="center"></td></tr>
<tr><td>Name : <b>JULUVA RAMKUMAR</b></td></tr>
<tr><td>Hall Ticket No : <b>3371215</b></td></tr>
<tr><td>Rank : <b>70789</b></td></tr>
<tr><td>The following amount is paid with regard to my
admission </td></tr>
<tr><td>Total Rs. ________________________</td></tr>
<tr><td>(In words Rupees </td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________)</td></tr>
<tr><td><br />&nbsp; <br /></td></tr>
<tr><td align="right">Signature of Payee</td></tr>
<tr><td><br /></td></tr>
<tr><td>Seal of Bank <br />in Receipt of Amount<br />Sc
roll. No.</td></tr>
<tr><td><br /></td></tr>
<tr><td align="center"><b>BANKERS COPY</b></td></tr>
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<tr><td align="right">DUPLICATE</td></tr>
<tr><td align="center"><b>Department of Technical Educat
ion</b></td></tr>
<tr><td align="center">Govt. of Andhra Pradesh</td></tr>
<tr><td align="center"><h3>POLYCET - 2013 (ADMISSIONS)</
h3></td></tr>
<tr><td align="center">ANDHRA BANK - ANDB0000533</td></
tr>

<tr><td style=" border-width:thin; border-style:dotted;

border-color:Teal" align="center">Account.No. 053310100036127</td></tr>
<tr><td align="center">Bank authorities to please <br /
>enter Hall Ticket Number </td></tr>
<tr><td align="right">Date : ______________</td></tr>
<tr><td align="center"></td></tr>
<tr><td>Name : <b>JULUVA RAMKUMAR</b></td></tr>
<tr><td>Hall Ticket No : <b>3371215</b></td></tr>
<tr><td>Rank : <b>70789</b></td></tr>
<tr><td>The following amount is paid with regard to my
admission </td></tr>
<tr><td>Total Rs. ________________________</td></tr>
<tr><td>(In words Rupees </td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________)</td></tr>
<tr><td><br />&nbsp; <br /></td></tr>
<tr><td align="right">Signature of Payee</td></tr>
<tr><td><br /></td></tr>
<tr><td>Seal of Bank <br />in Receipt of Amount<br />Sc
roll. No.</td></tr>
<tr><td><br /></td></tr>
<tr><td align="center"><b>COLLEGE COPY</b></td></tr>
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<tr><td align="right">TRIPLICATE</td></tr>
<tr><td align="center"><b>Department of Technical Educat
ion</b></td></tr>
<tr><td align="center">Govt. of Andhra Pradesh</td></tr>
<tr><td align="center"><h3>POLYCET - 2013 (ADMISSIONS)</
h3></td></tr>
<tr><td align="center">ANDHRA BANK - ANDB0000533</td></
tr>
<tr><td style=" border-width:thin; border-style:dotted;
border-color:Teal" align="center">Account.No. 053310100036127</td></tr>
<tr><td align="center">Bank authorities to please <br /
>enter Hall Ticket Number </td></tr>
<tr><td align="right">Date : ______________</td></tr>
<tr><td align="center"></td></tr>
<tr><td>Name : <b>JULUVA RAMKUMAR</b></td></tr>
<tr><td>Hall Ticket No : <b>3371215</b></td></tr>
<tr><td>Rank : <b>70789</b></td></tr>
<tr><td>The following amount is paid with regard to my
admission </td></tr>
<tr><td>Total Rs. ________________________</td></tr>
<tr><td>(In words Rupees </td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________</td></tr>
<tr><td>_______________________)</td></tr>
<tr><td><br />&nbsp; <br /></td></tr>
<tr><td align="right">Signature of Payee</td></tr>
<tr><td><br /></td></tr>

<tr><td>Seal of Bank <br />in Receipt of Amount<br />Sc

roll. No.</td></tr>
<tr><td><br /></td></tr>
<tr><td align="center"><b>CANDIDATE COPY</b></td></tr>
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