Print Date

30-Aug-2013

CHALLAN FORM FOR PAYMENT OF EMPLOYEE'S STATE INSURANCE/EMPLOYEES PROVIDENT CONTRIBUTION

CHALLAN FORM FOR EMPLOYEES' PROVIDENT FUND CONTRIBUTION ONLY

ORIGINAL

1 Name & Address of factory/establishment

PROJECT OFFICER APRPRP TPMU SEETHAMPETA & ITDA COMPLEX

ITDA COMPLEX,SEETHAMPETA,SRIKAKULAM,SRIKAKULAM,ANDHRA PRADESH

EPFO ESIC

2 Establishments Code Number

GR/VSP/00070087/000 EPF
8

EPS
8

EDLI
8 38253

3. Number os Subscribers/Employees 4 Total Wages 5 Month of contribution EPFO

ESIC

40,434 # Month January 2010

40,434

ESIC B:ESIC Fund XXII 183 TOTAL 5,054.00 4,852.00 Account No.1

A:EPF Account Number I Employer's contribution Employee's contribution Adm. Charges Inspection Charges Interest Damages Others/demand letter no. & date * Total Mode of Payment 0 0 0 6,356 Cheque/DD No 1,504 4,852 445 0 0 0 0 445 0 0 0 3,367
11691

II

X 3,367

XXI

4 0 0 0 0 183 Date 0 0 0 4
09-Jul-2013

449.00 0.00 0.00 0.00 0.00 10,355.00 Cash

Signature
# : To be remitted by 15th of following month **strike out whichever is not applicable

Name,designation & Seal of Authorised official Contact No. Acknowledgement

Received Rs. Rupees Cash/Cheque/DD No. Drawn on. Date of Presentation Date of Realisation Date of Credit

10,355.00 ten thousand three hundred fifty-five only

11691

Branch Name Branch Code No.

09-Jul-2013

dated.

Bank scroll No. Date

Authorised Signature & Seal of Receiving Bank

Print Date

30-Aug-2013

CHALLAN FORM FOR PAYMENT OF EMPLOYEE'S STATE INSURANCE/EMPLOYEES PROVIDENT CONTRIBUTION

CHALLAN FORM FOR EMPLOYEES' PROVIDENT FUND CONTRIBUTION ONLY

DUPLICATE

1 Name & Address of factory/establishment

PROJECT OFFICER APRPRP TPMU SEETHAMPETA & ITDA COMPLEX

ITDA COMPLEX,SEETHAMPETA,SRIKAKULAM,SRIKAKULAM,ANDHRA PRADESH

EPFO ESIC

2 Establishments Code Number

GR/VSP/00070087/000 EPF
8

EPS
8

EDLI
8 38253

3. Number os Subscribers/Employees 4 Total Wages 5 Month of contribution EPFO

ESIC

40,434 # Month June 2013

40,434

ESIC A:EPF Account Number B:ESIC Fund XXII 183 TOTAL 5,054.00 4,852.00 Account No.1

I Employer's contribution Employee's contribution Adm. Charges Inspection Charges Interest Damages Others/demand letter no. & date * Total Mode of Payment 0 0 0 6,356 Cheque/DD No 1,504 4,852

II

X 3,367

XXI

445 0 0 0 0 445 0 0 0 3,367

11691

4 0 0 0 0 183 Date 0 0 0 4
09-Jul-2013

449.00 0.00 0.00 0.00 0.00 10,355.00 Cash

Signature
# : To be remitted by 15th of following month **strike out whichever is not applicable

Name,designation & Seal of Authorised official Contact No. Acknowledgement

Received Rs. Rupees Cash/Cheque/DD No. Drawn on. Date of Presentation Date of Realisation Date of Credit

10,355.00 ten thousand three hundred fifty-five only

11691

Branch Name Branch Code No.

09-Jul-2013

dated.

Bank scroll No. Date

Authorised Signature & Seal of Receiving Bank

Print Date

30-Aug-2013

CHALLAN FORM FOR PAYMENT OF EMPLOYEE'S STATE INSURANCE/EMPLOYEES PROVIDENT CONTRIBUTION

CHALLAN FORM FOR EMPLOYEES' PROVIDENT FUND CONTRIBUTION ONLY

TRUPLICATE

1 Name & Address of factory/establishment

PROJECT OFFICER APRPRP TPMU SEETHAMPETA & ITDA COMPLEX

ITDA COMPLEX,SEETHAMPETA,SRIKAKULAM,SRIKAKULAM,ANDHRA PRADESH

EPFO ESIC

2 Establishments Code Number

GR/VSP/00070087/000 EPF
8

EPS
8

EDLI
8 38253

3. Number os Subscribers/Employees 4 Total Wages 5 Month of contribution EPFO

ESIC

40,434 # Month June 2013

40,434

ESIC A:EPF Account Number B:ESIC Fund XXII 183 TOTAL 5,054.00 4,852.00 Account No.1

I Employer's contribution Employee's contribution Adm. Charges Inspection Charges Interest Damages Others/demand letter no. & date * Total Mode of Payment 0 0 0 6,356 Cheque/DD No 1,504 4,852

II

X 3,367

XXI

445 0 0 0 0 445 0 0 0 3,367

11691

4 0 0 0 0 183 Date 0 0 0 4
09-Jul-2013

449.00 0.00 0.00 0.00 0.00 10,355.00 Cash

Signature
# : To be remitted by 15th of following month **strike out whichever is not applicable

Name,designation & Seal of Authorised official Contact No. Acknowledgement

Received Rs. Rupees Cash/Cheque/DD No. Drawn on. Date of Presentation Date of Realisation Date of Credit

10,355.00 ten thousand three hundred fifty-five only

11691

Branch Name Branch Code No.

09-Jul-2013

dated.

Bank scroll No. Date

Authorised Signature & Seal of Receiving Bank

Print Date

30-Aug-2013

CHALLAN FORM FOR PAYMENT OF EMPLOYEE'S STATE INSURANCE/EMPLOYEES PROVIDENT CONTRIBUTION

CHALLAN FORM FOR EMPLOYEES' PROVIDENT FUND CONTRIBUTION ONLY

QUADRUPLICATE

1 Name & Address of factory/establishment

PROJECT OFFICER APRPRP TPMU SEETHAMPETA & ITDA COMPLEX

SEETHAMPETA,SRIKAKULAM,SRIKAKULAM,ANDHRA PRADESH
EPFO ESIC

2 Establishments Code Number

GR/VSP/00070087/000 EPF
8

EPS
8

EDLI
8 38253

3. Number os Subscribers/Employees 4 Total Wages 5 Month of contribution EPFO

ESIC

40,434 # Month June 2013

40,434

ESIC A:EPF Account Number B:ESIC Fund XXII 183 TOTAL 5,054.00 4,852.00 Account No.1

I Employer's contribution Employee's contribution Adm. Charges Inspection Charges Interest Damages Others/demand letter no. & date * Total Mode of Payment 0 0 0 6,356 Cheque/DD No 1,504 4,852

II

X 3,367

XXI

445 0 0 0 0 445 0 0 0 3,367

11691

4 0 0 0 0 183 Date 0 0 0 4
09-Jul-2013

449.00 0.00 0.00 0.00 0.00 10,355.00 Cash

Signature
# : To be remitted by 15th of following month **strike out whichever is not applicable

Name,designation & Seal of Authorised official Contact No. Acknowledgement

Received Rs. Rupees Cash/Cheque/DD No. Drawn on. Date of Presentation Date of Realisation Date of Credit

10,355.00 ten thousand three hundred fifty-five only

11691

Branch Name Branch Code No.

09-Jul-2013

dated.

Bank scroll No. Date

Authorised Signature & Seal of Receiving Bank