Bank Copy Employees' State Insurance Corporation

Depositors Copy Employees' State Insurance Corporation

State Bank of India

(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH) Challan No. 01611116333965 Party code : Name of Factory/Estt./Party : Address:

State Bank of India

(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)

USE CBS SCREEN No :-

USE CBS SCREEN No :-

7127
Challan Date :

7127
Challan Date :

16/11/2011

Challan No. 01611116333965 Party code : Name of Factory/Estt./Party : Address: Mode of Payment Cheque/DD No :

16/11/2011

16000104030000905 ASSTT. ENGINEER ( O & M ) RAJASTHAN RAJYA VIDYUT MANDAL

Default Address1 Default Address2 DUNGARPUR

16000104030000905
ASSTT. ENGINEER ( O & M ) RAJASTHAN RAJYA VIDYUT MANDAL Default Address1 Default Address2 DUNGARPUR

Cash Amount Periods Dated :

Mode of Payment Cheque/DD No :

Cash Dated :

Drawn on (Name of the Bank) : Remittance Details Type

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

16947
Rupees Sixteen Thousand Nine Hundred Forty-Seven Only

Contribution

16947

Oct2011

Total

16947
Rupees Sixteen Thousand Nine Hundred Forty-Seven Only

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

Total (in words)

(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.

Journal No.
Branch Stamp and Signature of Cashier

Branch Stamp and Signature of Cashier

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

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