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Tatus Govt./ Govt. Aided/ University/ University Aided/UnaidedPvt. Address of Communication State PIN Permanent Account No.(PAN) Fax No, Telephone No E-Mail Address Name of Bank Branch Name Br. Code:- Address State PIN Fax No, Telephone No Account Type Savings Bank / Current Account Account Number (16 Digit) Banker s IFSC Code: Banker s MICR Code: I/ We declare that all the information I / We have provided are true in all respect and it is my/our Main Account and I/We am/are aut.

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