Combined Challan A/c No.

1, 2, 10, 21, & 22 STATE BANK OF INDIA EMPLOYEE'S PROVIDENT FUND ORGANISATION Use Separate Challan for Each Month Establishment Code No. Due for the Month of: No. of Subscribers Total Wages S. No. Particulars A/c No. 1 1789 5850 536 A/c No. 1

Original/Duplicatet/Triplicate/Quadrulicate

M. P./ 15925

Account Group No. .. Paid by Cheque/ Cash.. month MAR 17 48749 A/c No. 2 A/c No. 10 4061 year 2012 A/c No. 10 Days Date of Payment 17 48749 A/c No. 21 244 A/c No. 22 A/c No. 21 17 48749 Total 6094 5850 7 543 month year

1. Employer's Contribution 2. Employee's Contribution 3. Adm Charges 4. Insp. Charges 5. Penal Demages 6. Mise Payment (Interest 7q) Total Amount in Words:Name of Establishment

7639

536

4061

244 For Bank use only 12487

12487

Twelve thousand three hundred ninty two only

Amount Received Rs.

0

Address Name of Depositor Signature of the Depositor

For Cheques Only Date of Presentation Amount of the realisation Name of the Branch Branch Code No.

ulicate