Account No.

01
(EP.F.)

ORIGINAL

(USE SEPARATE CHALLAN FOR EACH MONTH)

CHALLAN
STATE BANK OF INDIA
EMPLOYEES' PROVIDENT FUNQ ORGANISATION

~STABLlSHMENT

CODE No.

DJ I I I I I

PAID BY:

CASH/CHEQUE/DRAFT

DUES FOR THE MONTH OF

Particulars

S.No.

AMOUNT
Rupees

1.

Employer's

2.

Member's share of PF Contribution

3.

Employer's

4.

Member's share of Past Accumulations

5.

Penal damages

6.

Interest on Securities

7.

Miscellaneous

SEAL OF THE BANK

Paise

share of PF Contribution

share OfPast Contribu.tion

TOTAL
(in words)
Paid into the credit of EPF Alc. No. 01 on behalf of

Name of Establishment.
Address

.
.

Rupees

Amount Received Rs
For cheques only

:
(for Bank's use only)
P
DDMM

Signature of the Depositor

'-

Name of the Depositor

Date of Presentation

Date of Realisation

8
Particulars of DRAFT/CHEQUE:

(If payment is by cheque)

Name of the Bank

Branch

Draft/Cheque

No.

DDMM

YYYY

Date:

Details of Cash (Notes & Coins)

Amount

Denomination

Rupees

No.

Paise

Total

(Size: 19 x 13 CIIl Colour - White)

6/23

YYYY

tEEBffiEE

H. Cashier P.O./Scroll Tr. (P.T.O.)

To be filled in by the Employer

Account No. 02
(E.P.F.)

(USE SEPARATE CHALLAN FOR EACH MONTH)

ORIGINAL

CHALLAN
STATE BANK OF INDIA
EMPLOYEES' PROVIDENT FUND ORGANISATION
ESTABLISHMENT

CODE No.

rn I I I

I I

PAID BY :

f'

~SH/CHEQU~DRAFT

DUES FOR THE MONTH OF

S.No.

Particulars

1.

Administration

2.

Inspection Charges

3.

Penal damages

4.

Miscellaneous

AMOUNT
Rupees

Paise

SEAL

9F THE

BANK

Charges

TOTAL
(in words)
Paid into the credit of EPF Ale. No. 02 on behalf of
Name of Establishment.
Address

.
"

Rupees

Amount Received Rs
For cheques only

(for Bank's use only)

P

o
Signature of the Depositor

Name of the Depositor

Date of Presentation
.

Date of Realisatieft

EEEE

H. Cashier P.O.lSeroll Tr. (P.T.O.)

8
To be filled in by the Employer
Particulars

of DRAFT/CHEQUE:

(If payment is by cheque)

Name of the Bank

Branch

Draft/Cheque

No.

DDMM

YYYY

Details of Cash (Notes & Coins)

Denomination

No.

Amount

Rupees

Paise

Total

(Size: 19 x 13 cm Colour 6/24

Yellow),

M M

.
Y

CEIJJ
~

Account No. 10
Pension Fund

(USE SEPARATE CHALLAN FOR EACH MONTH)

ORIGINAL
CHAlLAN
STATE BANK OF INDIA
EMPLOYEES' PRQVIDENT FUND ORGANISATION
ESTABLISHMENT

CODE No.

DJ f

r.1 \. I

-1,':;;1

~ CA5H1CHEQUEIDRAFT

PAID BY:

DUES FOR THE MONTH OF

1.

Employer's

2.

Penal" damages

3.

Miscellaneous

SEAL OF THE BANK

Paise

AMOUNT
Rupees

Particulars

S.No.

FPF Contribution

.
TOTAL
(in words)

Paid into the credit of FPF Ale. No. 10 on behalf of

Name of Establishment.'
Address

.
.

Signature of the DepoSitor

Name of the Depositor

Rupees .............................

:-:

(for Bank's use only}

Amount Received Rs .....................
P
For cheques only
Y
D D M M
Date of Presentation

To be fl11edin by the Employer

(If payment is by cheque)

Name of the Bank

Branch

OraftlChequeNo.

DDMM

YYYY

Details of Cash (Notes & Coins)

Amount

Oenominati?O No.

Rupees

Paise

Total

(Size: 19 x 13 cm Colour. -

EEm
.. ~ ..
DJ lj:liJ

Date of Realisation

H. Cashier P.OJScroU Tr. (P.T.O.)

Particulars of DRAFT/CHEQUE:

Pink)

(USE SEPARATE CHALLAN FOR EACH MONTH)

Account No. 21
(EDLI)

ORIGINAL
CHALLAN
STATE BANK OF INDIA
EMPLOYEES' PROVIDENT FUND ORGANISATION
E~TABUSHMENT

DJ

CODE No.

MM
/ DUES-FOR THE MONTH OF

YYY

I 1

\.

CASH/CHt=QUEIDRAFT

QD'MM

YY

AMOUNT
Rupees

Paise

YY

11\9\

DATEOFPAYMENTrnrn

Particulars

S.No.

PAID BY :

1119\

rn

SEAL OF THE BANK

-'

1.

EDlI Fund Contribution

2.

Penal damages

3.

Miscellaneous
TOTAL

.
(in words)

Paid into the credit of EDlI Alc. No. 21 on behalf of

Rupees ...

Name of Establishment.
....... ....................
Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount Received Rs
For cheques only

Signature of the Depositor

Date of Presentation

Name of the Depositor

Date of Realisation

(for Bank's use only)

P
DDMM

8
To be filled in by the Employer
(If payment is by cheque)

Name of the Bank.

Branch

Draft/Cheque

No.

DDMM

YYYY

Details of Cash .(Notes & Coins)

Amount

Denomination

Rupees

No.

Paise

Total

(Size: 19 x 13 cm Colour-.
6/26

Blue)

YYYY

EBEEffitE

H. Cashier P.O.lScroll Tr. (P.T.O.)

Particulars of DRAFT/CHEQUE:

.
.

Account No. 22
(EDU)

(USE SEPARATECHALLAN

FOR EACH MONTH)

ORIGINAL
CHALLAN
STATE BANK OF INDIA
EMPLOYEES' PROVIDENT FUND ORGANISATION
ESTABLISHMENT

CD 1 I 1 11

CODE No.

MM

DUES FOR THE MONTH OF

S.No.

CD

YYY

11

19

D
Y

Particulars

1.

Administration

2.

Inspection Charges

3.

Penal damages

4.

Miscellaneous

1 CASH/CHEQUE/DRAFT

PAID BY:

DDMM

CD CD

DATE OF PAYMENT

AMOUNT
Rupees

Paise

yy

yy

1119

SEAL OF THE BANK

Charges

TOTAL
(in words)
Paid into the credit of EDLI Nc. No. 22 on behalf of
Name of Establishment
Address

Rupees

.
.

'

Amount Received Rs
For cheques only

(for Bank's use only)

P

Date of Presentation

Name of the Depositor

Date of Realisation

8
(If payment is by cheque)

Name of the Bank

Branch

Draft/Cheque

No.

DDMM

YYYY

Details of Cash (Notes & Coins)

Amount

Denomination. No.

Rupees

Paise

Total

(Size: .t 9 x 13 cm Colour 6/27

Green)

YYYY

EEtBffiEB

H. Cashier P.O./Scroll Tr. (P.T.O.)

To be filled in by the Employer

.
-

DDMM
Signature of the Depositor

Particulars of DRAFT/CHEQUE: