Book No. …………….

Receipt No. …………….

Book No. …………….

Receipt No. ……………

Received from …………… the sum of Rs. ………… (in words) ……………… on account of …………………. Rs. ………………

Chief A/c. Officer/ Authorized Officer Entered in Cash Book, Page No. ……….

Accountant

Received from ………………. the sum of Rs. ……………. (in words) …………………….. on account of ……………. Rs. ………………….

Chief A/c. Officer/ Authorized Officer Employees’ State Insurance Corporation