NAME DOJ BRANCH BANK A/C NO BASIC P.F H.R.A E.S.

I

: : : :

SALARY FOR THE MONTH OF G

ROLL NO : BASIC(Rs) : TOTAL DAYS: PAY DAYS :

CONVEYANCE LOAN

OTHERS OTHERS

GROSS DEDUCTIONS

NETT PAY : Rs (IN WORDS) :

EMPLOYER SIGNATURE

EMPLOYEE SIGNATURE

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