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This document is a challan form for paying employee insurance contributions to the Employees' State Insurance Fund. It contains details such as the employer code, name and address of the factory, number of employees, total wages, and breakdown of employee and employer contributions totaling Rs. 45,772. The form serves as a receipt acknowledging the payment amount and bank details for the transaction.

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seth_chemi
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240 views1 page

Esic Format

This document is a challan form for paying employee insurance contributions to the Employees' State Insurance Fund. It contains details such as the employer code, name and address of the factory, number of employees, total wages, and breakdown of employee and employer contributions totaling Rs. 45,772. The form serves as a receipt acknowledging the payment amount and bank details for the transaction.

Uploaded by

seth_chemi
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 PDF, TXT or read online on Scribd
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E.S.I.C. E.S.I.C.

Challan No. Challan No.


EMPLOYEES' STATE INSURANCE FUND ACCOUNT NO.-1 EMPLOYEES' STATE INSURANCE FUND ACCOUNT NO.-1
PAY-IN-SLIP FOR CONTRIBUTION STATE BANK OF INDIA PAY-IN-SLIP FOR CONTRIBUTION STATE BANK OF INDIA

Station Dated Station Dated


Paid into credit of the Employee's State Paid into credit of the Employee's State
Particulars of Amount Particulars of Amount
Insurance Fund. Insurance Fund.
Cash/Cheque No. Cash/Cheque No.
Rs. Ps. Account No. 1 Rs. 0.00 Rs. Ps. Account No. 1 Rs. 0.00
0.0 Rupees Forty Five Thousand Seven 0 0.0 Rupees Forty Five Thousand Seven
Hundred Seventy two Only. Hundred Seventy two Only.

In Cash/by Cheque (on realisation) for payment In Cash/by Cheque (on realisation) for payment
of contribution as per details given of contribution as per details given
below under the Employees State Insurance below under the Employees State Insurance
Total 0 0.0 Act, 1948. For the Month of Total 0 0.0 Act, 1948. For the Month of

Employer's Code No. 35-131-111 Deposited by Employer's Code No. Deposited by

Name and Address of Name and Address of


Factory/Establishment Factory/Establishment
0

No. of Employees No. of Employees 0

Total Wages Total Wages 0.00

Employees' Contribution Rs. Employees' Contribution Rs. 0.00


Employers' Contribution Rs Employers' Contribution Rs 0.00
0
Total Contribution Rs. 0.00 Total Contribution Rs. 0.00

(For use in Bank) (For use in Bank)


ACKNOWLEDGEMENT ACKNOWLEDGEMENT
Received payment with Cast/Cheque/Draft No.
Dated for Rs. 0.00 Dated for Rs. 0.00
In Word Rs In Word Rs

Drawn on Bank in favour of Drawn on Bank in favour of


Employees State Insurance Fund Account No. 1 Employees State Insurance Fund Account No. 1
Sl. No. in Bank's Scroll Sl. No. in Bank's Scroll
Authorised Signatory Authorised Signatory

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