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) : 05114106866811

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

Challan No. (Registration ID/Ref. No. in SBI CBS) : 05114106866811

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

51001086810000999

Challan Date :

14/3/2014

51001086810000999
CHARIOT ENTERPRISES

Challan Date :

14/3/2014

CHARIOT ENTERPRISES
NO. 2340, AMMAN NAGAR 9TH CROSS STREET, KATTUPAKKAM, CHENNAI.

NO. 2340, AMMAN NAGAR 9TH CROSS STREET, KATTUPAKKAM, CHENNAI.

Mobile No: Mode of Payment Cheque/DD/Ref. No. : Drawn on (Name of the Bank) : Remittance Details Total Total (in words)

--Cheque
Dated :

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

--Cheque
Dated :

State Bank of India,Kattupakkam

Drawn on (Name of the Bank) : Remittance Details

State Bank of India,Kattupakkam

3822
Rupees Three Thousand Eight Hundred Twenty-Two Only

Type Contribution

Amount

Periods

3822

Feb2014

Denomination

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

Total Total (in words)

3822
Rupees Three Thousand Eight Hundred Twenty-Two 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.