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
[Link].
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 [Link]
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
[Link].
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 [Link] 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
[Link].
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 [Link] 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
[Link].
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 [Link] 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
[Link].
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:
