Surname
(In Block Letter)
Name of Examiner
Fathers Name
___________________________________________________________________
Institute Name: ________________________
E-Mail ID : __________________________
Sr.
No
1
Particulars
Date of
Exam
Examining
Answer books
(amount in words
Name
Branch :_______________________
Rate
(Rs.)
Amount
(Rs.)
) Grand total
Deductions if any
Net amount payable
: ___________________
Received
Address : ___________________
: ___________________
CERTIFICATE
I hereby certify that above details are correct and I am a resident of India and that the provision of
the Income tax-act 1961 is applicable to me and shall comply with it.
Date :
Date :
_____________________________
Name& Signature of GTU coordinator
FOR GTU USE ONLY
Date:
Controller of Examination
Account officer
Surname
(In Block Letter)
Name of Examiner
Fathers Name
___________________________________________________________________
Institute Name: ________________________
E-Mail ID : __________________________
Sr. Particulars
Subject name
No
(with code)
1
Manuscript
preparation charges
2
Postal charges
(attach receipt)
Branch :_______________________
Mobile No: ______________________
No. of answer
Rate
Amount
books assessed (Rs.)
(Rs.)
____________
Grand total
Deductions if any
Net amount payable
Name
: ___________________
Received
Address : ___________________
: ___________________
CERTIFICATE
I hereby certify that above details are correct and I am a resident of India and that the provision of
the Income tax-act 1961 is applicable to me and shall comply with it.
Date :
Date :
_____________________________
Name& Signature of GTU coordinator
FOR GTU USE ONLY
Date:
Controller of Examination
Account officer