Bank Copy

Depositors Copy

Employees' State Insurance Corporation

Employees' State Insurance Corporation

State Bank of India

State Bank of India

(CHALLAN CAN BE

(CHALLAN CAN BE

USE CBS SCREEN NO. 8888

SUBMITTED AT ANY SBI

Fee Type 56

BRANCH)

27000138750000905

Challan Date :

Name of
Factory/Estt./Party :

XEN 220 KV GSS RRVPNL PINDWARA

Address:

220 KV GSS,
RRVPNL,

2/1/2015

Challan No. (Registration ID/Ref. No. in SBI CBS) : 02715100125817

Party code :

27000138750000905

Name of
Factory/Estt./Party :

XEN 220 KV GSS RRVPNL PINDWARA

Address:

220 KV GSS,
PINDWARA.

9414061083

Mobile No:

Cheque/DD/Ref. No. :

Dated :

Drawn on (Name of the Bank) :

Remittance Details

Cash

Cheque/DD/Ref. No. :

Dated :

1081

Total (in words)

Rupees One Thousand Eighty-One Only

Drawn on (Name of the Bank) :

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

Type

Amount

Periods

Contribution

1081

Dec2014

Total

1081

Total (in words)

Rupees One Thousand Eighty-One Only

Total
(For Bank's use)
Deposited Date:

Remittance Details

Total

Denomination

9414061083

Mode of Payment

Cash

Mode of Payment

Challan Date :

RRVPNL,

PINDWARA.
Mobile No:

Fee Type 56

BRANCH)

Challan No. (Registration ID/Ref. No. in SBI CBS) : 02715100125817

Party code :

USE CBS SCREEN NO. 8888

SUBMITTED AT ANY SBI

(For Bank's use)

D D

M M

Y Y Y Y

Deposited Date:

D D M

Y Y Y Y

Journal No.

Journal No.

Branch Stamp and Signature of Cashier

Branch Stamp and Signature of Cashier

Notes :

Notes :

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

2)Strike out the not applicable option.

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

2)Strike out the not applicable option.

2/1/2015