Biju Patnaik University of Technology, Orissa

Rourkela





SAMPLE STATEMENT SHEET (to be sent while sending the consolidated Demand Draft)


 

Name of the College :...............................................................................................................

Semester
No. of student Without Fine
No. of student With Fine of Rs. 500/-
No. of student With Fine of Rs. 1000/-
No. of Back Papers
7th
A
B
C
D
Amount ->
A X 1500
B X 2000
C X 2500
D X 200
TOTAL AMOUNT
5th
P
Q
R
S
Amount ->
P X 1500
Q X 2000
R X 2500
S X 200
TOTAL AMOUNT

DD. No : ......................... Date : .........................

Drawn on Bank :..................................................

Payable at : .........................................................

 

Remarks if any :

DIRECTOR EXAMINATIONS