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  • Employees State Insurance Corporation Temporary Identity Certificate

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    Sadhana Ayre
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    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Mr. Bhaveshkumar Pistolwala Insurance No : 3810085623 Date of Registration :09 / 08 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender

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    3810085623

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    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Mr. Bhaveshkumar Pistolwala Insurance No : 3810085623 Date of Registration :09 / 08 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender

    Copyright:

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

    Employees State Insurance Corporation Temporary Identity Certificate

    Uploaded by

    Sadhana Ayre
    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Mr. Bhaveshkumar Pistolwala Insurance No : 3810085623 Date of Registration :09 / 08 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender

    Copyright:

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

    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE

    Insured Person : Mr. Bhaveshkumar Pistolwala Insurance No : 3810085623 Date of Registration :09/08/2011

    YOUR REGISTRATION DETAILS


    Employee Name : Name of Father / Husband: Marital Status : Present Address :

    Mr. Bhaveshkumar Pistolwala d Unmarried 2NS FLOOR GALA NO. 8-11 ADITYA COMPLEX, Bharuch, Gujrat None

    Type of Disability : Date of Birth : Gender : Permanent Address :

    None 22/06/1978 M 2NS FLOOR GALA NO. 8-11 ADITYA COMPLEX, Bharuch, Gujrat

    Dispensary / IMP : Current Employer Details Employer's Code No. : Sub Unit's Code No. : Date of Appointment : Name of Employer : Address of Employer :

    Previous Employer Details

    35000017480000011 38350017480020011 09/07/2009 HDFC STANDARD LIFE INSURANCE CO, LTD. address1, address2, address3, Vadodara, Gujrat

    Employer's Code No. : Sub Unit's Code No. : Previous Insurance No. : Name of Employer : Address of Employer :

    None None None None None

    Family Details:
    Name Relationship with the Employe Date of Birth Whether Residing with I State District

    ----

    ---

    ---

    ----

    ---

    ---

    Nominee Details:
    Name of Nominee Relationship with IP Percentage Address of Nominee

    Dummy

    100

    lk, Bharuch, Gujrat

    Documents Uploaded: Please Verify the Above Particulars. Please Notify Your Employer or in the Branch Office Address Below Incase of Any Information Found Incorrect.
    To get permanent ID card, employee is requested to visit the following branch office to get biometric & photo captured by this date 24/08/2011 , in the Below Branch Office : BO-BHARUCH BO-BHARUCH 0 or any nearest ESIC Bio-metric Camp Locations.
    Signature / LTI of Registered Employee / IP :

    Affix Your Family Photograph Here.(Attested and Stamped by Employer / ESIC Official)

    Mobile Number :
    NOTE:
    1. Please Keep this Printout for Future Reference and Bring this Along with Your Photo ID Card for All Your Claim Benefits and Medical Benefits . 2. This Copy Should be Retained with You until the Biometric Card is Dispatched . 3. Employer to please affix employee and his family photo here and attest with official stamp across . Signature / Stamp of ESIC Officer / Employer

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