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  • Esic 53

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    arunov05
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    This document is an application for changing particulars of an insured person in the Employees' State Insurance Corporation. It requests changing the insured person's branch office or dispensary, as well as other details like name, father's name, age, address, etc. The application is forwarded to the relevant branch office for necessary action and updating of records.

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    esic-53

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    This document is an application for changing particulars of an insured person in the Employees' State Insurance Corporation. It requests changing the insured person's branch office or dispensary, as well as other details like name, father's name, age, address, etc. The application is forwarded to the relevant branch office for necessary action and updating of records.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    33 views1 page

    Esic 53

    Uploaded by

    arunov05
    This document is an application for changing particulars of an insured person in the Employees' State Insurance Corporation. It requests changing the insured person's branch office or dispensary, as well as other details like name, father's name, age, address, etc. The application is forwarded to the relevant branch office for necessary action and updating of records.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ,fld@ESIC-53 (2) vkS"k/kky; ls vkS"k/kky;

    ßfuxe fgUnh i=kkpkj dk Lokxr djrk gSÞ From Dispensary ________________ to Dispensary ________________
    deZpkjh jkT; chek fuxe (3) vU; ifjorZu ;Fkk
    EMPLOYEES’ STATE INSURANCE CORPORATION Other changes e.g. _____________________________________________
    [chekÑr O;fDr ds 'kk[kk dk;kZy;@vkS"k/kky; ds fooj.kksa esa uke] firk dk uke] vk;q] irk ;k
    ifjorZu gsrq izkFkZuk i=k] Name, Father's name, age, address or _____________________________
    [Application for change in particulars of Insured Person regarding change of ____________________________________________________________
    Branch Office/Dispensary]
    ifjorZu dk dkj.k
    izs"kd Reason for change ________________________________________
    From :
    chekÑr O;fDr dk uke chek la[;k
    Hkonh;
    Name of the Insured Person ______________ Ins. No. ______________
    Yours faithfully
    irk
    chekÑr O;fDr ds gLrk{kj] vaxwBs dk fu'kku
    Address ___________________________________________________________
    Signature/L.T.I. of Insured Person
    lsok esa
    To rkjh[k@Date _____________
    {ks=kh; funs'kd@'kk[kk izcU/kd@ la[;k
    The Regional Director/Branch Manager/ No. __________________________
    izHkkjh fpfdRlk vf/kdkjh] izcU/kd] 'kk[kk dk;kZy; _________________________ dks vko';d dkjZokbZ
    Medical Officer In-charge gsrq vxzsf"krA geus vkosnu ds uke esa ifjorZu vius vfHkys[kksa esa vafdr dj fy;k gSA
    deZpkjh jkT; chek fuxe Forwarded to the Manager, Branch Office _______________________
    E.S.I. Corporation for necessary action. The change in the name of the applicant has been duly
    ____________________ carried out by us in our records.
    egksn; fu;kstd ds gLrk{kj
    Sir, Signature of the employer
    esjs vkcaVu esa fuEu izdkj ifjorZu vkSj@;k esjs vfHkys[k esa fuEu ifjorZu djus dh irk
    Ñik djsa %& Address ______________________
    I request you to please change my allotment as follows and/or to carry _______________________________
    out the following changes in my records. ________________________________
    (1) 'kk[kk dk;kZy; ls 'kk[kk dk;kZy;
    From Branch Office _____________ to Branch Office _____________ rkjh[k@Date ______________ dwV la[;k Code No. ______________

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