EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Date Month Year
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
0 Date Month Year
Employer's Code Name of Factory/Estt. & Address
Bank & Branch Code
Employer's Code Name of Factory/Estt. & Address
Bank & Branch Code 0 0 0 Cash .. Cheque *. D.D. .. Dated Period of Contribution
0
Mode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total 0
Cash .. Cheque *. D.D. .. Dated Period of Contribution
Mode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total
Regular Contribution. Interest Damages .. Others
Regular Contribution. Interest Damages .. Others
Total Wages
0 0 0
Total Wages
Total amount (in words) #R.O. Demand Letter No. & Date
Total amount (in words) #R.O. Demand Letter No. & Date
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor) Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1 For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank (to be filled by Depositor)
(Acknowledgment) For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank
Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Date .. M onth Year
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
0 .. Date M onth Year
Employer's Code
Bank & Branch Code
Employer's Code
Bank & Branch Code 0 0 0 Cash .. Cheque *. D.D. .. Dated Period of Contribution
Name of Factory/Estt. & Address
Name of Factory/Estt. & Address
M ode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total 0
Cash .. Cheque *. D.D. .. Dated Period of Contribution
JANUARY 2009
M ode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total
Regular Contribution. Interest Damages .. Others
Regular Contribution. Interest Damages .. Others
Total Wages
0 0 0
Total Wages
Total amount (in words) #R.O. Demand Letter No. & Date
Total amount (in words) #R.O. Demand Letter No. & Date
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor) Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1 For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank (to be filled by Depositor)
(Acknowledgment) For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank
Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
