Father/

Husband's Lastname/ Date of Birth Married/

Sr.No Name Name surname Gender (dd.mm.yyyy) Unmarried Designation Branch
1
Date Of
Joining Personal/Company Personal/Compa
(dd.mm.yyyy) UAN ESIC Number Address PIN Code mobile number ny email ID
 PF
PF Nominee
If monthly PF Nominee relation
Rate/ Gross whether on Nominee date of with
Monthly Salary CTC: Y/N Name birth member
Sr.No. Name UAN PAN AADHAR
Bank Account Number Bank IFSC Code Marital Status MOBILE NUMBER
 Date Of Birth Date Of Birth Date Of Birth
Father (dd.mm.yyyy) or Mother (dd.mm.yyyy) or Spouse's (dd.mm.yyyy) or
Sr.No Name Name AGE Name AGE Name AGE
 Date Of Birth Date Of Birth
(dd.mm.yyyy) or (dd.mm.yyyy) or
Child 1 Name AGE Relation Child 2 Name AGE
 Date Of Birth
(dd.mm.yyyy) or
Relation Child 3 Name AGE Relation Child 4 Name
Date Of Birth
(dd.mm.yyyy) or
AGE Relation
 If monthly salary than its salary breakup
Sr.No. Name Gross Monthly Salary or Daily Rate
y breakup
 Date Of Date Of
Joining Leaving
Sr.No. Name (dd.mm.yyyy) (dd.mm.yyyy) Reason