Bank Copy Depositors Copy Employees' State ... - ESIC

1 Bank CopyState Bank of IndiaDepositors CopyEmployees' State insurance CorporationState Bank of IndiaEmployees' State insurance corporation (CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)Challan Date :Party code :(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)Party code :USE CBS SCREEN NO. 8888 Fee Type 56 USE CBS SCREEN NO. 8888 Fee Type 56 Challan Date :Challan No. (Registration ID/Ref. No. in SBI CBS) : Challan No. (Registration ID/Ref. No. in SBI CBS) :Mode of PaymentCheque/DD/Ref. No. :Drawn on (Name of the Bank) :Dated :Remittance DetailsTotalTotal (in words)Mode of PaymentDated :Drawn on (Name of the Bank) :Remittance DetailsTypeAmountPeriodsTotalTotal (in words)Denomination1000 X500 X100 X50 X20 X10 XTotal5 XJournal X1 XName of :Deposited Date:Deposited Date:Journal Stamp and Signature of CashierBranch Stamp and Signature of CashierDDMMYYYYYDDMMYYY(For Bank's use)(For Bank's use)1)No Charges/Commission to be charged from the )Strike out the not applicable :Name of :Address:Address:Mobile No:Mobile No.

2 Notes :Cheque/DD/Ref. No. :1)No Charges/Commission to be charged from the )Strike out the not applicable option.