monthly EPF challan in pdf formate

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COMBINED CHALLAN OF A/C NO. 1,2.10,21 & 22
(STATE BANK OF INDIA )
ORIGINAL / DUPLICATE
TRIPLICATE / QUARDPLICATE
EMPLOYEES PROVIDENT FUND ORGANSATION
(USE SEPARATE CHALLAN FOR EACH MONTH)
ESTABLISHMENT CODE NO. : M.H..VSH/115847 ACCOUNT GROUP. VI PAID BY CHEQUE/CASH_________
M M D D Y Y
EMPLO-EES SHARE

DATE OF PAYMENT

USES FOR THE MOTH OF :
EMPLO-EES SHARE

TOTAL NO. OF SUBSCRIBERS
TOTAL WAGES DUE
A/C NO. 1
A/C NO.2
A/C NO. 10
A/C NO. 21
A/C NO. 22
TOTAL
S. NO. PARTICULARS
Amount in Rupees…
1. EMPLOYERS SHARE OF COUNT.
2. EMPLOYEES SHARE OF COUNT.
3. ADM. CHARGES
4. INSP. CHARGES
5. PENAL DAMAGES
6. MISC. PAYMENT (PAST
ACCUMULATIOUS ONLY)
TOTAL
( AMOUNT IN WORDS-:
NAME OF ESTABLISHMENT
(FOR BANK USE ONLY)
AMOUNT RECEIVE RS._______________________
ADDRESS-:
FOR CHEQUES ONLY_________________________
NAME OF DEPOSITOR-:
___________
DATE OF PRESENTATIONS____________________
SIGNATURE OF DEPOSITOR____________________________________________________________________________________
DATE OF REALISATION_______________________
BRANCH NAME____________________________
BRANCH CODE____________________________
(TO BE FILLED IN BY IMPLOYERS)……………
NAME OF THE BANK
CHEQUE NO._
DATE-: