Bank Copy

Depositors Copy

Employees' State Insurance Corporation

Employees' State Insurance Corporation

State Bank of India

State Bank of India

(CHALLAN CAN BE

(CHALLAN CAN BE

USE CBS SCREEN NO. 8888

SUBMITTED AT ANY SBI

Fee Type 56

BRANCH)

69000500670001001

69000500670001001

Name of
Factory/Estt./Party :

NEW GENERATION SECURITY

UG248H, SUSHANT SHOPPING ARCADE,

SUSHANT LOK-1, GURGAON, HARYANA

Address:

UG248H, SUSHANT SHOPPING ARCADE,

8826115050

Mobile No:

NEW GENERATION SECURITY

Address:

16/12/2014

Challan No. (Registration ID/Ref. No. in SBI CBS) : 06914129225577

Party code :

Challan Date :

Name of
Factory/Estt./Party :

Mobile No:

Fee Type 56

BRANCH)

Challan No. (Registration ID/Ref. No. in SBI CBS) : 06914129225577

Party code :

USE CBS SCREEN NO. 8888

SUBMITTED AT ANY SBI

Cheque/DD/Ref. No. :

SUSHANT LOK-1, GURGAON, HARYANA

8826115050
Cheque

Mode of Payment

Cheque

Mode of Payment

Dated :

Dated :

Cheque/DD/Ref. No. :

Drawn on (Name of the Bank) :

Drawn on (Name of the Bank) :

Remittance Details

Remittance Details

Total

107576

Total (in words)

Rupees One Lakh Seven Thousand Five Hundred Seventy-Six

Only

Denomination

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

Challan Date :

Type

Amount

Periods

Contribution

107576

Nov2014

Total

107576

Total (in words)

Rupees One Lakh Seven Thousand Five Hundred

Seventy-Six Only

Total
(For Bank's use)
Deposited Date:

(For Bank's use)

D D

M M

Y Y Y Y

Deposited Date:

D D M

Y Y Y Y

Journal No.

Journal No.

Branch Stamp and Signature of Cashier

Branch Stamp and Signature of Cashier

Notes :

Notes :

1)No Charges/Commission to be charged from the depositor.

2)Strike out the not applicable option.

1)No Charges/Commission to be charged from the depositor.

2)Strike out the not applicable option.

16/12/2014