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Esic Challan

This document is a challan form from the Employees' State Insurance Corporation for depositing contributions into account number 1. It contains fields for the employer code, factory name and address, bank and branch code, payment mode and details like number of employees, contribution amounts, total wages, payment total, authorized signatures, and acknowledgment of receipt. The form is dated for the month of January 2009.

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rgsr2008
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3K views7 pages

Esic Challan

This document is a challan form from the Employees' State Insurance Corporation for depositing contributions into account number 1. It contains fields for the employer code, factory name and address, bank and branch code, payment mode and details like number of employees, contribution amounts, total wages, payment total, authorized signatures, and acknowledgment of receipt. The form is dated for the month of January 2009.

Uploaded by

rgsr2008
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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EMPLOYEES' STATE INSURANCE CORPORATION

Challan Form for Deposit in A/C No. 1


Date Month Year

EMPLOYEES' STATE INSURANCE CORPORATION


Challan Form for Deposit in A/C No. 1
0 Date Month Year

Employer's Code Name of Factory/Estt. & Address

Bank & Branch Code

Employer's Code Name of Factory/Estt. & Address

Bank & Branch Code 0 0 0 Cash .. Cheque *. D.D. .. Dated Period of Contribution
0

Mode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total 0

Cash .. Cheque *. D.D. .. Dated Period of Contribution

Mode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total

Regular Contribution. Interest Damages .. Others

Regular Contribution. Interest Damages .. Others

Total Wages

0 0 0

Total Wages

Total amount (in words) #R.O. Demand Letter No. & Date

Total amount (in words) #R.O. Demand Letter No. & Date

Signature __________________________________________ Name & Designation - Seal of Authorised Signatory

Signature __________________________________________ Name & Designation - Seal of Authorised Signatory

(Acknowledgment) (to be filled by Depositor) Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1 For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank (to be filled by Depositor)

(Acknowledgment) For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank

Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1

EMPLOYEES' STATE INSURANCE CORPORATION


Challan Form for Deposit in A/C No. 1
Date .. M onth Year

EMPLOYEES' STATE INSURANCE CORPORATION


Challan Form for Deposit in A/C No. 1
0 .. Date M onth Year

Employer's Code

Bank & Branch Code

Employer's Code

Bank & Branch Code 0 0 0 Cash .. Cheque *. D.D. .. Dated Period of Contribution

Name of Factory/Estt. & Address

Name of Factory/Estt. & Address

M ode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total 0

Cash .. Cheque *. D.D. .. Dated Period of Contribution


JANUARY 2009

M ode of Payment [ Tick (p ) mode used] Cheque/DD No. Drawn on (Name of the Bank). Details of Payment [Tick (p ) mode used] No. of Employees Employees Contribution Employer's Contribution #Interest #Damages #Others Total

Regular Contribution. Interest Damages .. Others

Regular Contribution. Interest Damages .. Others

Total Wages

0 0 0

Total Wages

Total amount (in words) #R.O. Demand Letter No. & Date

Total amount (in words) #R.O. Demand Letter No. & Date

S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory

S ignature __________________________________________ Name & Designation - Seal of Authorised Signatory

(Acknowledgment) (to be filled by Depositor) Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1 For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank (to be filled by Depositor)

(Acknowledgment) For use in Bank Bank Scroll No. . Dated .. Authorised Signature & Seal of the Receiving Bank

Received Rs. (Rs. ______________________________________________ Only) In Cash/by Cheque/DD No. Dated (subject to Realisation) drawn on (Bank) in favour of ESIC A/C No.1

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