REMITTER'S COPY BANK COPY

A.P. LABOUR WELFARE BOARD'S COPY

A.P. LABOUR WELFARE BOARD'S COPY A.P. LABOUR WELFARE BOARD'S COPY
( To be sent along with Annexure-I)
( To be sent along with Annexure-I) ( To be sent along with Annexure-I)
A.P.L.W. FUND COLLECTION ACCOUNT
A.P.L.W. FUND COLLECTION ACCOUNT A.P.L.W. FUND COLLECTION ACCOUNT
Account No : 142210011200206, Bank Name :UNION BANK OF INDIA
Account No : 142210011200206, Bank Name :UNION BANK OF INDIA Account No :142210011200206, Bank Name:UNION BANK OF INDIA

Branch Name : ___________________________ Branch Name : ___________________________ Branch Name : ___________________________

Code No : _ ______ Date : _______________ Code No : _ ______ Date : _______________ Code No : _ ______ Date : _______________

Paid into the credit of A.P Labour Welfare Fund Collection of Paid into the credit of A.P Labour Welfare Fund Collection of Paid into the credit of A.P Labour Welfare Fund Collection of

Account No : 142210011200206 Account No : 142210011200206 Account No : 142210011200206

Union Bank of India, Seetharampuram Branch, Vijayawada. Union Bank of India, Seetharampuram Branch, Vijayawada. Union Bank of India, Seetharampuram Branch, Vijayawada.
IFSC Code : UBIN0805106 IFSC Code : UBIN0805106 IFSC Code : UBIN0805106

Rs: _____________ ( Rupees : __________________________________ Rs: _____________ ( Rupees : __________________________________ Rs: _____________ ( Rupees : __________________________________

_______________________________________________ only) _______________________________________________ only) _______________________________________________ only)

Towards Subscription of Labour Welfare Fund: Towards Subscription of Labour Welfare Fund: Towards Subscription of Labour Welfare Fund:

1. For the Year : _______________________ 1. For the Year : _______________________ 1. For the Year : _______________________

2. No. of Workers : _______________________ 2. No. of Workers : _______________________ 2. No. of Workers : _______________________

Remittance is made by the following : Remittance is made by the following : Remittance is made by the following :
1. Name of Officer : __________________________ 1. Name of Officer : __________________________ 1. Name of Officer : __________________________
2. Code : _______________ 2. Code : _______________ 2. Code : _______________
If remittance is made by the employer : If remittance is made by the employer : If remittance is made by the employer :

1. Name of the Estt : ______________________________________________ 1. Name of the Estt : ______________________________________________ 1. Name of the Estt : ______________________________________________

2. Address : ___________________________________________________ 2. Address : ___________________________________________________ 2. Address : ___________________________________________________

______________________________________________________ ______________________________________________________ ______________________________________________________

3. Estt. Code : ______________ 3. Estt. Code : ______________ 3. Estt. Code : ______________

Remitter Signature & Stamp Remitter Signature & Stamp Remitter Signature & Stamp

FOR BANK USE ONLY FOR BANK USE ONLY FOR BANK USE ONLY
Received Rs: _____________ ( Rupees : ________________________ Received Rs: _____________ ( Rupees : ________________________ Received Rs: _____________ ( Rupees : ________________________
_______________________________________________ only) _______________________________________________ only) _______________________________________________ only)

Receiver's Signature , Date & Stamp Receiver's Signature , Date & Stamp Receiver's Signature , Date & Stamp