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) ?Use separate challan for each month. ?Write legibly without any overwriting / correction / erasures. ?Include Interest U/S 7Q for all belated remittances. ?Pay the dues through local cheque only. (To be filled in by the Bank) Challan Reference No. Date of Presentation: Date Of Realisation Date of Credit: M M Y Y Y Y M M Y Y Y YD D
