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E.S.I.

C STATEMENT
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Grand

Month
July
August
September
October
November
December
January
February
March
April
Total

ESI Strength

ESI Wage

0.00

EEE Cont.

0.00

EER Cont.

0.00

Total Cont.
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Cheque No.
065702

Cheque Dt.
17.08.2009

STATEMENT
8/28/2016
Name of the Bank
VIJAYA BANK, RANIPET

EMPLOYEE'S STATE INSURANCE CORPORATION


Challan Form for Deposit in A/c No. 1
Employer's Code
Region Code

Employer Code

Date
1
8

Industry Code

Month
0
8

EMPLOYEE'S STATE INSURANCE CORPO


Challan Form for Deposit in A/c No

TRIPLICATE
For Depositer

Year
2

Employer's Code
0

Region Code

Employer Code

Bank & Branch Code

Cash
Cheque
D.D.

Name of Factory /
Establishment & Address

Month

Nature of Payment [Tick (P )]


Total Wages:

Dated:

17.08.2009

Cash
Cheque
D.D.

VIJAYA BANK, RANIPET

Period of Contribution

Regular Contribution

July

Year
Interest
Others

Mode of Payment [Tick (P )]


Cheque No.
065702
Drawn on (Name of the Bank/Branch)

P
-

Period of Contribution

Total Wages:

No. of Employees:

Month

Rs.

Regular Contribution

July

0.00

No. of Employees:
Rs.

Ps.

R
00
00

00

(RUPEES SEVEN THOUSAND SIX HUNDRED ONLY)

R.O.Demand Letter No. & Date

Nature of Payment [Tick (P )]

Damages

Rs.

Employee's Contribution
Employer's Contribution
Interest
Damages
Others
Total
Total Amount (in words)

Bank & Branch C

Name of Factory /
Establishment & Address
Mode of Payment [Tick (P )]
Cheque / D.D. No.
065702
Drawn on (Name of the Bank/Branch)

Date
1

Industry Code

Employee's Contribution
Employer's Contribution
Interest
Damages
Others
Total
Total Amount (in words)

(RUPEES SEVEN THOUSAND SIX HUNDRE

R.O.Demand Letter No. & Date

Signature
Bank
Seal

Bank
Seal
Name & Designation - Seal of Authorised Signatory

Acknowledgement (to be filled by Depositor)


Received (Rs.
0
Amount (in Words)
(RUPEES SEVEN THOUSAND
SIX HUNDRED ONLY)
065702
17.08.2009
In Cash/by Cheque/DD no.
Dated
Subject to Realisation) Drawn on

For us in Bank
Bank Scroll No.
Date

Name & Designation

Acknowledgement (to be filled by D


Received (Rs.
0
Amount (in Words)
(RUPEES SEVEN THOUSAND
SIX HUNDRED ONLY)
065702
17.08.2009
In Cash/by Cheque/DD no.
Dated
Subject to Realisation) Drawn on

Bank Scro
Date

VIJAYA BANK, RANIPET


(Bank) in favour of ESIC A/c No.1

Authorised Signature & Seal of the Receiving Bank

VIJAYA BANK, RANIPET


(Bank) in favour of ESIC A/c No.1

Authorised Sig

EMPLOYEE'S STATE INSURANCE CORPORATION


Challan Form for Deposit in A/c No. 1
Date
8

Month
0
8

Original / Duplicate /
Triplicate /
Quadruplicate

Year
2

Bank & Branch Code

0
Mode of Payment [Tick (P )]
065702

Dated:

17.08.2009

VIJAYA BANK, RANIPET

July

Year
Interest
Others

Damages

Rs.

Ps.
0
0

00
00

00

(RUPEES SEVEN THOUSAND SIX HUNDRED ONLY)


Signature

Name & Designation - Seal of Authorised Signatory

Acknowledgement (to be filled by Depositor)


For us in Bank
Bank Scroll No.

Authorised Signature & Seal of the Receiving Bank