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) : 06913101229592

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

Challan No. (Registration ID/Ref. No. in SBI CBS) : 06913101229592

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

69000500670001001

Challan Date :

14/1/2013

69000500670001001
NEW GENERATION SECURITY

Challan Date :

14/1/2013

NEW GENERATION SECURITY

UG248H, SUSHANT SHOPPING ARCADE,, SUSHANT LOK-1, GURGAON, HARYANA, .

UG248H, SUSHANT SHOPPING ARCADE,, SUSHANT LOK-1, GURGAON, HARYANA, .

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

8826115050 Cheque 0
Dated :

Mobile No: Mode of Payment

8826115050 Cheque 0
Dated :

14/1/2013

Cheque/DD/Ref. No. : Drawn on (Name of the Bank) : Remittance Details

14/1/2013

Drawn on (Name of the Bank) : Remittance Details Total Total (in words)

Axis bank,gurgaon

Axis bank,gurgaon

12978
Rupees Twelve Thousand Nine Hundred Seventy-Eight Only

Type Contribution

Amount

Periods

12978

Dec2012

Denomination

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

Total Total (in words)

12978
Rupees Twelve Thousand Nine Hundred Seventy-Eight 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.