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) : 07013123047226

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

Challan No. (Registration ID/Ref. No. in SBI CBS) : 07013123047226

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

70000351700000305

Challan Date :

13/10/2013

70000351700000305

Challan Date :

13/10/2013

Ms. Verdant Life Sciences Pvt Ltd

Plot No. 55, J N Pharma City Parawada

Ms. Verdant Life Sciences Pvt Ltd Plot No. 55, J N Pharma City Parawada

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

9052522201 Cheque 158537 13/10/2013 State Bank of India,Lankelapalem

Dated :

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

9052522201 Cheque 158537

Dated :

13/10/2013

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

Drawn on (Name of the Bank) : Remittance Details

State Bank of India,Lankelapalem

12439
Rupees Twelve Thousand Four Hundred Thirty-Nine Only

Type Contribution

Amount

Periods

12439

Sep2013

Denomination

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

Total Total (in words)

12439
Rupees Twelve Thousand Four Hundred Thirty-Nine 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.