Original / Duplicate / Original / Duplicate /

Triplicate / Quadruplicate E.S.I.C. Challan No. …….. Triplicate / Quadruplicate E.S.I.C. Challan No. ……..
EMPLOYEE'S STATE INSURANCE FUND ACCOUNT NO.01 EMPLOYEE'S STATE INSURANCE FUND ACCOUNT NO.01
PAY-IN-SLIP FOR CONTRIBUTION PAY-IN-SLIP FOR CONTRIBUTION
STATE BANK OF INDIA STATE BANK OF INDIA

Station : Date Station : Date

Particulars of Cash / Cheque Rs. P. Particulars of Cash / Cheque Rs. P.

0 0

TOTAL 0 TOTAL 0

Paid into the credit of the employee's State Insurance Fund A/c No.01 Rs. 0 Paid into the credit of the employee's State Insurance Fund A/c No.01 Rs. 0
Rupees: Rs. Fortyone Thousand One Hundred Fortytwo Only Rupees: Rs. Fortyone Thousand One Hundred Fortytwo Only

#REF! #REF!

Employer's Code No : Employer's Code No :

Name & Address of Factory / : Name & Address of Factory / :
Establishment Deposited By Establishment Deposited By

No. of Employee's : No. of Employee's : 0

Total Wages : Total Wages : 0

Employee's Contribution Rs. Employee's Contribution Rs. 0.00

Employer's Contribution Rs. Employer's Contribution Rs. 0.00

Total Contribution Rs. Total Contribution Rs. 0.00

(For use in Bank) (To be filled by depositor) (For use in Bank) (To be filled by depositor)
ACKNOWLEDGEMENT ACKNOWLEDGEMENT
#REF!

drawn in in favour of Employee's drawn in in favour of Employee's

State Insurance Fund Account No.01 Sl. No. in Bank's Scroll ……… State Insurance Fund Account No.01 Sl. No. in Bank's Scroll ………

Authorised Signatory Authorised Signatory

Dated: ………………… of the receiving Bank Dated: ………………… of the receiving Bank
#REF!
lan No. ……..
01

Rs. P.

Deposited By

0.00

0.00

0.00

e filled by depositor)

avour of Employee's

horised Signatory
the receiving Bank