ICCONS - Payment Form
Payment should be made in favour of  "Project Director, SRCCD'           Account Number:  57036240676
Bank : SBI, Medical College, Thiruvananthapuram                                    IFSC : SBIN0070029
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File No : *
Name : *
Therapy / Consultation : *
Required
Amount Paid :
Transaction ID *
Date of Transaction : *
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Type of Service *
Name of Therapist
Select the therapist from concerned Department
Dept. of Clinical Psychology
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Dept. of Speech Language Pathology
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Dept. of Linguistics
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Dept. of Physiotherapy
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Dept. of Special Education
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email Id. *
Remarks
Agreement *
This receipt will be cancelled if there is any discrepancy between the amount you paid and the amount given here.
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