CHALLAN CHALLAN

WEST BENGAL POLLUTION CONTROL BOARD WEST BENGAL POLLUTION CONTROL BOARD
"Paribesh Bhavan", 10A, LA Block "Paribesh Bhavan", 10A, LA Block
Sector-III, Salt Lake, Kolkata-98 Sector-III, Salt Lake, Kolkata-98
(1st Copy) (2nd Copy)
(To be retained at the Receiving (To be sent by the bank to the W.B.P.C.B.
Branch) through link Branch)
PAY-IN-SLIP PAY-IN-SLIP

UNITED BANK OF INDIA UNITED BANK OF INDIA

Branch........................................................ Date.......................... ..... Branch........................................................ Date.......................... ....

_____________________________________________________ _____________________________________________________

_____________________________________________________ _____________________________________________________

_____________________________________________________ _____________________________________________________
(Name & Address of the Company / Unit) (Name & Address of the Company / Unit)

Unit Code Unit Code

(for units with unit code, optional) (for units with unit code, optional)
Category Red/Orange/Green (Please •/ tick) Category Red/Orange/Green (Please •/ tick)

Please Credit: A/C NO. 1096050101684 Please Credit: A/C NO. 1096050101684
WEST BENGAL POLLUTION CONTROL BOARD WEST BENGAL POLLUTION CONTROL BOARD

Particular of Fees Code Amount * Particular of Fees Code Amount *

Consent to Establish (NOC) R4D .................................... Consent to Establish (NOC) R4D ....................................
Consent to Operate R4C Rs..... .......................... Consent to Operate R4C Rs..... ..........................
Analysis Charges (Air/Water) R4M Rs..... .......................... Analysis Charges (Air/Water) R4M Rs..... ..........................
Haz. Waste Authorisation R4N Rs..... .......................... Haz. Waste Authorisation R4N Rs..... ..........................
Bio-Med Waste Authorisation R4O Rs..... .......................... Bio-Med Waste Authorisation R4O Rs..... ..........................
Import Clearance R4P Rs..... .......................... Import Clearance R4P Rs..... ..........................
Laboratory Recognition/ R4q Rs..... .......................... Laboratory Recognition/ R4q Rs..... ..........................
Registration/renewal Registration/renewal

Other (Please Specify) R4H Rs..... ...................... Other (Please Specify) R4H Rs..... ......................
Fine (Please Specify) R4Z Rs..... ...................... Fine (Please Specify) R4Z Rs..... ......................
Arrear fees (Specify Period) R4AR Rs..... ...................... Arrear fees (Specify Period) R4AR Rs..... ......................
Advance fees(Specify Period) R4AD Rs..... ...................... Advance fees(Specify Period) R4AD Rs..... ......................
TOTAL Rs. TOTAL Rs.

* Amount (current year) * Amount (current year)

Depositor's Name & Signature Depositor's Name & Signature

_______________________________________________________ _______________________________________________________
Particulars of Cash/Cheque/Draft Particulars of Cash/Cheque/Draft

Rupees (in words) ..................................................................................... Rupees (in words) .....................................................................................

................................................................................................................... ...................................................................................................................

Signature of Receiving Cashier Signature of Receiving Cashier

_____________________________________ _______________________________________________________
Challan passed.........................................................................

(Name & Signature of the Officer with seal)

CHALLAN CHALLAN
WEST BENGAL POLLUTION CONTROL BOARD WEST BENGAL POLLUTION CONTROL BOARD
"Paribesh Bhavan", 10A, LA Block "Paribesh Bhavan", 10A, LA Block
Sector-III, Salt Lake, Kolkata-98 Sector-III, Salt Lake, Kolkata-98
(3rd Copy) (4th Copy)
(To be sent by the unit along with application) (To be retained by the depositor)
PAY-IN-SLIP PAY-IN-SLIP

UNITED BANK OF INDIA UNITED BANK OF INDIA

Branch........................................................ Date.......................... ..... Branch........................................................ Date.......................... .....

_____________________________________________________ _____________________________________________________

_____________________________________________________ _____________________________________________________

_____________________________________________________ _____________________________________________________
(Name & Address of the Company / Unit) (Name & Address of the Company / Unit)

Unit Code Unit Code

(for units with unit code, optional) (for units with unit code, optional)
Category Red/Orange/Green (Please •/ tick) Category Red/Orange/Green (Please •/ tick)

Please Credit: A/C NO. 1096050101684 Please Credit: A/C NO. 1096050101684
WEST BENGAL POLLUTION CONTROL BOARD WEST BENGAL POLLUTION CONTROL BOARD

Particular of Fees Code Amount * Particular of Fees Code Amount *

Consent to Establish (NOC) R4D .................................... Consent to Establish (NOC) R4D ....................................
Consent to Operate R4C Rs..... .......................... Consent to Operate R4C Rs..... ..........................
Analysis Charges (Air/Water) R4M Rs..... .......................... Analysis Charges (Air/Water) R4M Rs..... ..........................
Haz. Waste Authorisation R4N Rs..... .......................... Haz. Waste Authorisation R4N Rs..... ..........................
Bio-Med Waste Authorisation R4O Rs..... .......................... Bio-Med Waste Authorisation R4O Rs..... ..........................
Import Clearance R4P Rs..... .......................... Import Clearance R4P Rs..... ..........................
Laboratory Recognition/ R4q Rs..... .......................... Laboratory Recognition/ R4q Rs..... ..........................
Registration/renewal Registration/renewal
Other (Please Specify) R4H Rs..... ...................... Other (Please Specify) R4H Rs..... ......................
Fine (Please Specify) R4Z Rs..... ...................... Fine (Please Specify) R4Z Rs..... ......................
Arrear fees (Specify Period) R4AR Rs..... ...................... Arrear fees (Specify Period) R4AR Rs..... ......................
Advance fees(Specify Period) R4AD Rs..... ...................... Advance fees(Specify Period) R4AD Rs..... ......................
TOTAL Rs. TOTAL Rs.

* Amount (current year) * Amount (current year)

Depositor's Name & Signature Depositor's Name & Signature

_______________________________________________________ _______________________________________________________
Particulars of Cash/Cheque/Draft Particulars of Cash/Cheque/Draft

Rupees (in words) ..................................................................................... Rupees (in words) .....................................................................................

................................................................................................................... ...................................................................................................................

Signature of Receiving Cashier Signature of Receiving Cashier

_____________________________________ _______________________________________________________