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OD.z,:ooo8d dxd,)l *q ar cts/ Name of the Bank. ..:................5a$ I snqTl Branch........sodatr dJDsor csDn i vn-w wr pi warT FullAddress of the Branch.c) a-tl ffu'qEiR d- :Tt s.f. rqrff * ffiq. affe ny I{EFT Payment to rny B AJc. through Core Banking $ysterndi Mandatory : Please enclose attested oopy of first page of pass Book I CancBlied MICR cheque teaf

Note ; Please enclose xerox copy of flrst page of S.B. A/c. pass book duly attested by employer for ensurlngthe cheque reaches to the correct party.

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tloqdd,re-3ffiF 3-n dsadle,rte:,ilqrm i{q d?F' xwl- fq rydflt'd Fonm 3A for the current year sent/enclosed.J!aad e*e6o fJad>d qnr G'etq ff ql sisrq]-d Contribution for the current financlal year13.2 r,D;1FoFtML:T3ltso"il

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No. and oarticulars oforevious emolover. anv (ifsb whether, h'e id a inerirber

FORM NO.sName of theEmolovee(in Block [etters

Father Name (orHusband's Nahein case of marriedwomen) date of ioinino theEstt. in 6ase 6f olc

, FORM NO.{OFather name (or Husband'sName in case of married wom

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7/30/2019 Final Form 19

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- il5tF, + fid-d{ + s$+{r + ftq / FoR THE USE OF COMMTSSTONER'S OFFTCE*qr or iiisrd:t Tfe' A.rerur Gqr rm ft*lm qGft qi cq{ zr til ziizi; .Gfu frqr rrcr rAccount Settled in ParUFull entered in F.21N24t2l9 and Withdrawal RegisterftR-6 Clerk ei.q. S.S.Under Rs,...................fi. eir{ ifqr ffitlsr r +6

M.O./Cheque.. fr'qr *fenA/c No. KNl. No.3i-{rilrrSection.

s................ii)..............t Vqan* fu crRdl """""'.""""'\,emrdcr qEr (Brrrt So ti atyM.O. Commission if any..............tr{rasr Hrtr +c ersft r*-r+Net Amount to be paid by M.O........

+wfffi/s.sT.fr.sTr' Accounts Officer/ApFCRt'rdDate frqs wgwr + sr+.r + frq / FoR usE rN GASH sEcroNtw g+ (+n) fur dqr 1 + ilr+ va eq. fr.frd........ .* *+ iiqrqrtr Wrf,rt + ftq Hffiil |paid by inclusion in cheque No"""".',..'.. '....Date...........................vide cash Book (Bank) Account No. 1 debititem No.

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