Payment of gratutity format

I have attached the format Payment of gratutity format letter

COMBINED CHALLAN OF A/C NO. 1, 2, 10, 21 & 22 ORIGINAL
(STATE BANK OF INDIA) DUPLICATE
EMPLOYEE’S PROVIDENT FUND ORGANISATION TRIPLICATE
(USE SEPARATE CHALLAN FOR EACH MONTH) QUADRUPLICATE
ESTABLISHMENT CODE NO.    DL/ 123456_______        ACCOUNT GROUP NO.____________________________________ PAID  BY  CHEQUE  /  CA CHEQUE
M   M Y     Y D D M M Y Y
EMPLOYEES’ SHARE AUGUST 2011
DUES FOR THE MONTH OF DATE OF PAYMENT 2011
EMPLOYER’S SHARE AUGUST 2011
TOTAL NO. OF SUBSCRIBERS 6 6 6
A/C 1 A/C 10 A/C 21
TOTAL WAGES  DUE 35011 35011 35011
S. NO. PARTICULARS A/C  NO. 1 A/C NO. 2 A/C NO. 10 A/C NO. 21 A/C NO. 22          TOTAL
………..AMOUNT (IN RUPEES)…………
1 EMPLOYER’S SHARE OF CONT. 1286 2917 175 4378
2 EMPLOYEE’S SHARE OF CONT. 4203 4203
3 ADM. CHARGES 385 4 389
4 INSP. CHARGES
5 PENAL DAMAGES
6 MISC. PAYMENT (PAST
ACCUMULATIONS ONLY)
TOTAL 5489 385 2917 175 4 8970
AMOUNT IN WORDS RS.  
NAME OF ESTABLISHMENT :- (FOR BANK USE ONLY)
ADDRESS: – AMOUNT RECEIVED RS.
FOR CHEQUE ONLY
NAME OF DEPOSITOR DATE OF PRESENTATION
SIGNATURE OF THE DEPOSITOR DATE OF RELISATION
BRANCH NAME
BRANCH CODE
(TO BE FILLED IN BY EMPLOYER)
NAME OF THE BANK DATE

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