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. 01111118164773 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 :

16/12/2011

Challan No. 01111118164773 Party code : Name of Factory/Estt./Party : Address: Mode of Payment Cheque/DD No :

16/12/2011

11000801440000304 BLUE HEAVEN COSMETICS

39, DLF INDL. AREA KIRTI NAGAR, NEW DELHI, employer address2, .

11000801440000304
BLUE HEAVEN COSMETICS 39, DLF INDL. AREA KIRTI NAGAR, NEW DELHI, employer address2, .

Cheque
Dated :

Mode of Payment Cheque/DD No : Drawn on (Name of the Bank) : Remittance Details Total Total (in words) Denomination

Cheque
Dated :

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

110436
Rupees One Lakh Ten Thousand Four Hundred Thirty-Six Only

110436

Nov2011

Total

110436
Rupees One Lakh Ten Thousand Four Hundred Thirty-Six 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