EMPLOYEES' PROVIDENT FUND ORGANISATION
(Combined Challan for A/c No.1, 2, 10, 21 & 22)
Business No.
For the Month of:
VDR No.: ________________________
(To be filled in by EPFO)
(Amount in Rs.)
Sl.No.
Particulars
A/c No. 1
A/c No.2
A/c No.10
A/c No.21
A/c No.22
Total
Employees' Share
Employer's Share
Total
1. Contribution, Administrative / Inspection Charges
2(a). Interest Under Section 7Q
2(b). Damages Under Section 14B
3. Miscellaneous payments
Total
Mode of payment:(Tick)
Cheque
Cash
DD
Transfer
Date of Deposit:
Name of the Establishment:
Cheque/DD No.
Address:
Cheque/DD date
PIN
Amount Recvd.(Rs.)
Name of the Depositor:
Deposit Bank Code:
Signature of Depositor:
Deposit Branch name:
Instructions to the employer
Bank Name (on which Cheque/DD drawn)