Bank Copy Employees' State Insurance Corporation

Depositors Copy Employees' State Insurance Corporation

State Bank of India

(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)

State Bank of India

(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)

USE CBS SCREEN NO. 8888 Fee Type 56

USE CBS SCREEN NO. 8888 Fee Type 56

Challan No. (Registration ID/Ref. No. in SBI CBS) : 05213114570340

Party code : Name of Factory/Estt./Party : Address:

Challan No. (Registration ID/Ref. No. in SBI CBS) : 05213114570340

Party code : Name of Factory/Estt./Party : Address:

52000242260001099

Challan Date :

4/7/2013

52000242260001099
FAST TRACK SERVICES

Challan Date :

4/7/2013

FAST TRACK SERVICES

F11A,1st Floor,S. A.Trade Center, Ranigunj, Sec-Bad-5000 03.

F11A,1st Floor,S. A.Trade Center, Ranigunj, Sec-Bad-5000 03.

Mobile No: Mode of Payment Cheque/DD/Ref. No. : Drawn on (Name of the Bank) : Remittance Details Total Total (in words)

--Cheque
Dated :

Mobile No: Mode of Payment Cheque/DD/Ref. No. :

--Cheque
Dated :

Drawn on (Name of the Bank) : Remittance Details

3374
Rupees Three Thousand Three Hundred Seventy-Four Only

Type Contribution

Amount

Periods

3374

May2013

Denomination

1000 X 500 X 100 X 50 X 20 X 10 X 5X 2X 1X Total

Total Total (in words)

3374
Rupees Three Thousand Three Hundred Seventy-Four Only

(For Bank's use) Deposited Date:

D D M M Y Y Y Y

(For Bank's use) Deposited Date: D D M M Y Y Y Y

Journal No.
Branch Stamp and Signature of Cashier

Journal No.
Branch Stamp and Signature of Cashier

Notes :
1)No Charges/Commission to be charged from the depositor. 2)Strike out the not applicable option.

Notes :
1)No Charges/Commission to be charged from the depositor. 2)Strike out the not applicable option.