Esic Challan 2tv3b
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EMPLOYEES' STATE INSURANCE CORPORATION
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Challan Form for Deposit in A/C No. 1 Date
Employer's Code
Month
Year
Bank & Branch Code
Employer's Code
Name of Factory/Estt. & Address
Cash …….. Cheque …*…. D.D. ……..
Cheque/DD No.
Dated
Drawn on (Name of the Bank).
No. of Employees
Mode of Payment [ Tick (p ) mode used]
Total Wages
Employees Contribution Employer's Contribution #Interest #Damages #Others 0
Details of Payment [Tick (p ) mode used]
Period of Contribution
0
Regular Contribution……. Interest ……… Damages …….. Others ………
0
Employees Contribution Employer's Contribution #Interest #Damages #Others
0 0
Total
0
Total amount (in words)
Total amount (in words)
#R.O. Demand Letter No. & Date
#R.O. Demand Letter No. & Date
Total Wages
0
0
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor)
Cash …….. Cheque …*…. D.D. …….. Dated
No. of Employees
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
Year
0 0 0
Drawn on (Name of the Bank).
Regular Contribution……. Interest ……… Damages …….. Others ………
Month
Bank & Branch Code
Cheque/DD No.
Period of Contribution
Total
0
Date
Name of Factory/Estt. & Address
Mode of Payment [ Tick (p ) mode used]
Details of Payment [Tick (p ) mode used]
0
(Acknowledgment) For use in Bank
(to be filled by Depositor)
For use in Bank
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
EMPLOYEES' STATE INSURANCE CORPORATION
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Challan Form for Deposit in A/C No. 1 Date
……………..
Employer's Code
M onth
Year
Bank & Branch Code
Cash …….. Cheque …*…. D.D. ……..
Cheque/DD No.
Dated
Drawn on (Name of the Bank).
Period of Contribution
No. of Employees
M ode of Payment [ Tick (p ) mode used]
Total Wages
Employees Contribution Employer's Contribution #Interest #Damages #Others 0
Total amount (in words)
Year
Cash …….. Cheque …*…. D.D. …….. Dated
Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used]
M onth
0 0 0
Cheque/DD No. JANUARY 2009
Regular Contribution……. Interest ……… Damages …….. Others ………
Total
Date
Bank & Branch Code
Name of Factory/Estt. & Address
M ode of Payment [ Tick (p ) mode used]
Details of Payment [Tick (p ) mode used]
0 ……………..
Employer's Code
Name of Factory/Estt. & Address
Period of Contribution
Regular Contribution……. Interest ……… Damages …….. Others ………
No. of Employees
0
Employees Contribution Employer's Contribution #Interest #Damages #Others
0 0
Total
0
Total Wages
0
Total amount (in words)
#R.O. Demand Letter No. & Date
#R.O. Demand Letter No. & Date
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor)
(Acknowledgment) For use in Bank
(to be filled by Depositor)
For use in Bank
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Challan Form for Deposit in A/C No. 1 Date
Employer's Code
Month
Year
Bank & Branch Code
Employer's Code
Name of Factory/Estt. & Address
Cash …….. Cheque …*…. D.D. ……..
Cheque/DD No.
Dated
Drawn on (Name of the Bank).
No. of Employees
Mode of Payment [ Tick (p ) mode used]
Total Wages
Employees Contribution Employer's Contribution #Interest #Damages #Others 0
Details of Payment [Tick (p ) mode used]
Period of Contribution
0
Regular Contribution……. Interest ……… Damages …….. Others ………
0
Employees Contribution Employer's Contribution #Interest #Damages #Others
0 0
Total
0
Total amount (in words)
Total amount (in words)
#R.O. Demand Letter No. & Date
#R.O. Demand Letter No. & Date
Total Wages
0
0
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor)
Cash …….. Cheque …*…. D.D. …….. Dated
No. of Employees
Signature __________________________________________ Name & Designation - Seal of Authorised Signatory
Year
0 0 0
Drawn on (Name of the Bank).
Regular Contribution……. Interest ……… Damages …….. Others ………
Month
Bank & Branch Code
Cheque/DD No.
Period of Contribution
Total
0
Date
Name of Factory/Estt. & Address
Mode of Payment [ Tick (p ) mode used]
Details of Payment [Tick (p ) mode used]
0
(Acknowledgment) For use in Bank
(to be filled by Depositor)
For use in Bank
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
EMPLOYEES' STATE INSURANCE CORPORATION
EMPLOYEES' STATE INSURANCE CORPORATION
Challan Form for Deposit in A/C No. 1
Challan Form for Deposit in A/C No. 1 Date
……………..
Employer's Code
M onth
Year
Bank & Branch Code
Cash …….. Cheque …*…. D.D. ……..
Cheque/DD No.
Dated
Drawn on (Name of the Bank).
Period of Contribution
No. of Employees
M ode of Payment [ Tick (p ) mode used]
Total Wages
Employees Contribution Employer's Contribution #Interest #Damages #Others 0
Total amount (in words)
Year
Cash …….. Cheque …*…. D.D. …….. Dated
Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used]
M onth
0 0 0
Cheque/DD No. JANUARY 2009
Regular Contribution……. Interest ……… Damages …….. Others ………
Total
Date
Bank & Branch Code
Name of Factory/Estt. & Address
M ode of Payment [ Tick (p ) mode used]
Details of Payment [Tick (p ) mode used]
0 ……………..
Employer's Code
Name of Factory/Estt. & Address
Period of Contribution
Regular Contribution……. Interest ……… Damages …….. Others ………
No. of Employees
0
Employees Contribution Employer's Contribution #Interest #Damages #Others
0 0
Total
0
Total Wages
0
Total amount (in words)
#R.O. Demand Letter No. & Date
#R.O. Demand Letter No. & Date
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory
(Acknowledgment) (to be filled by Depositor)
(Acknowledgment) For use in Bank
(to be filled by Depositor)
For use in Bank
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
Received Rs. (Rs. ______________________________________________ Only)
Bank Scroll No. ……………. Dated ………………………..
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1
Authorised Signature & Seal of the Receiving Bank
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