Bank Copy

State Bank of India

Depositors Copy

Employees' State Insurance CorporationState Bank of India

Employees' State Insurance Corporation

(CHALLAN CAN BE SUBMITTED AT ANY SBI BRANCH)

16/12/2014Challan Date :69000500670001001Party 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

69000500670001001 16/12/2014Challan Date :

Challan No. (Registration ID/Ref. No. in SBI CBS) : 06914129225577 Challan No. (Registration ID/Ref. No. in SBI CBS) : 06914129225577

Mode of Payment

Cheque/DD/Ref. No. :

Drawn on (Name of the Bank) :

Dated :

Remittance Details

Total

Total (in words)

Cheque

107576

Rupees One Lakh Seven Thousand Five Hundred Seventy-Six Only

ChequeMode of Payment

Dated :

Drawn on (Name of the Bank) :

Remittance Details

Type Amount PeriodsTotal 107576

Total (in words) Rupees One Lakh Seven Thousand Five Hundred Seventy-Six Only

Denomination 1000 X500 X100 X50 X20 X10 X

Total

5 X

Journal No.

2 X1 X

Name of Factory/Estt./Party :

Deposited Date: Deposited Date:

Journal No.

Branch Stamp and Signature of Cashier Branch Stamp and Signature of Cashier

D D M M Y Y Y Y YD D M M Y Y Y

(For Bank's use) (For Bank's use)

1)No Charges/Commission to be charged from the depositor.2)Strike out the not applicable option.

Notes :

Name of Factory/Estt./Party :

NEW GENERATION SECURITY

Address: UG248H, SUSHANT SHOPPING ARCADE,SUSHANT LOK-1, GURGAON, HARYANA

Address: UG248H, SUSHANT SHOPPING ARCADE,SUSHANT LOK-1, GURGAON, HARYANA

Contribution 107576 Nov2014

Mobile No: Mobile No: 8826115050

NEW GENERATION SECURITY

8826115050

Notes :

Cheque/DD/Ref. No. :

1)No Charges/Commission to be charged from the depositor.2)Strike out the not applicable option.