Original / Duplicate / Triplicate / Quadruplicate

E.S.I.C.
PAY-IN-SLIP FOR CONTRIBUTION STATE BANK OF INDIA
Challan No. ……..
Original / Duplicate / Triplicate / Quadruplicate
E.S.I.C.
PAY-IN-SLIP FOR CONTRIBUTION STATE BANK OF INDIA
Challan No. ……..
EMPLOYEE'S STATE INSURANCE FUND ACCOUNT NO.01
EMPLOYEE'S STATE INSURANCE FUND ACCOUNT NO.01
Station : Particulars of Cash / Cheque
Date Rs. P.
Station : Particulars of Cash / Cheque 0
Date Rs. P. 0 TOTAL
TOTAL Paid into the credit of the employee's State Insurance Fund A/c No.01 Rs. 0 Rupees: R
0
0
Paid into the credit of the employee's State Insurance Fund A/c No.01 Rs. 0 Rupees: Rs. For
Employer's Code No Name & Address of Factory / Establishment
: : Deposited By
Employer's Code No Name & Address of Factory / Establishment
: : Deposited By
No. of Employee's Total Wages
: :
No. of Employee's Total Wages
: :
0 0
Employee's Contribution Rs. Employer's Contribution Rs. Total Contribution Rs. (For use in
Employee's Contribution Rs. Employer's Contribution Rs. Total Contribution Rs. ACKNOWLEDGEM
0.00 0.00 0.00
(To be filled by depositor)
drawn in State Insurance Fund Account No.01 Sl. No. in Bank's Scroll ………
in favour of Employee's
drawn in State Insurance Fund Account No.01 Sl. No. in Bank's Scroll ………
in favour of Employee's
Dated: …………………
Authorised Signatory of the receiving Bank
Dated: …………………
Authorised Signatory of the receiving Bank
#REF!
lan No. ……..
01
Rs. P. 0
0
Deposited By
0.00 0.00 0.00
e filled by depositor)
avour of Employee's
horised Signatory the receiving Bank