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Bank Copy Licensee Copy RSBCL Copy

ICICI BANK LTD ICICI BANK LTD ICICI BANK LTD

Deposit Branch Name :- Deposit Branch Name :- Deposit Branch Name :-


SOL ID :- ................ SOL ID :- ................ SOL ID :- ................
.................... .................... ....................

Challan Date : - 18- Challan Date : - 18- Challan Date : - 18-


Challan No : - 4800488 Challan No : - 4800488 Challan No : - 4800488
Jul-2024 Jul-2024 Jul-2024

Institution ID :- RSBCL(for Cash Only) Institution ID :- RSBCL(for Cash Only) Institution ID :- RSBCL(for Cash Only)

Institution ID :- RSBCH(for Fund Transfer Institution ID :- RSBCH(for Fund Transfer Institution ID :- RSBCH(for Fund Transfer
through ICICI cheque or DD) through ICICI cheque or DD) through ICICI cheque or DD)

Licensee 2302011 Licensee 2302011 Licensee 2302011


Name Charanwas/Puranabas Name Charanwas/Puranabas Name Charanwas/Puranabas
Kotra BASANT SINGH Kotra BASANT SINGH Kotra BASANT SINGH
SAMPAT SINGH SAMPAT SINGH SAMPAT SINGH

Licensee 2300819 Licensee 2300819 Licensee 2300819


RSBCL RSBCL RSBCL
Code Code Code

Amount (In figures);- 200000 Amount (In figures);- 200000 Amount (In figures);- 200000

Amount (In words);- Two Lakh Amount (In words);- Two Lakh Amount (In words);- Two Lakh

Cheque/DD No. ;- Cheque/DD No. ;- Cheque/DD No. ;-

Sign For Bank Use:- Depositor’s :- Sign For Bank Use:- Depositor’s :- Sign For Bank Use:- Depositor’s :-
................. ................. ................. ................. ................. .................

Amount (In figures);- 200000 Amount (In figures);- 200000 Amount (In figures);- 200000

Amount (In words);- Two Lakh Amount (In words);- Two Lakh Amount (In words);- Two Lakh

Cashier’s Signature Cashier’s Signature Cashier’s Signature


with Stamp with Stamp with Stamp

................. ................. .................

“I-Surepay logo and/or instruction for branches “I-Surepay logo and/or instruction for branches “I-Surepay logo and/or instruction for branches
to be part of deposit slip. Instruction: Branch to be part of deposit slip. Instruction: Branch to be part of deposit slip. Instruction: Branch
should not credit client's account directly and should not credit client's account directly and should not credit client's account directly and
the transaction should be routed through "I-Sure the transaction should be routed through "I-Sure the transaction should be routed through "I-Sure
Pay" using HCOREFEE menu option only.” Pay" using HCOREFEE menu option only.” Pay" using HCOREFEE menu option only.”

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