Scribd Logo
Upload

Welcome to Scribd!

  • Only For Form Feeding For Online Registration This Form Is Not For Treatment

    Uploaded by

    KL Sim
    13 views1 page
    This document is a temporary identity certificate from the Employees State Insurance Corporation for an insured person with insurance number 0. It provides basic registration details for the insured such as name, father/husband's name, date of birth, gender, addresses, employer information, family details, nominee details, and bank account information. The insured is asked to verify the provided particulars and notify their employer or branch office of any incorrect information, and to visit the branch office by a certain date to get their biometric and photo captured to obtain a permanent ID card.

    Original Description:

    Original Title

    EMPLOYEE DATA 3

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a temporary identity certificate from the Employees State Insurance Corporation for an insured person with insurance number 0. It provides basic registration details for the insured such as name, father/husband's name, date of birth, gender, addresses, employer information, family details, nominee details, and bank account information. The insured is asked to verify the provided particulars and notify their employer or branch office of any incorrect information, and to visit the branch office by a certain date to get their biometric and photo captured to obtain a permanent ID card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    13 views1 page

    Only For Form Feeding For Online Registration This Form Is Not For Treatment

    Uploaded by

    KL Sim
    This document is a temporary identity certificate from the Employees State Insurance Corporation for an insured person with insurance number 0. It provides basic registration details for the insured such as name, father/husband's name, date of birth, gender, addresses, employer information, family details, nominee details, and bank account information. The insured is asked to verify the provided particulars and notify their employer or branch office of any incorrect information, and to visit the branch office by a certain date to get their biometric and photo captured to obtain a permanent ID card.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    EMPLOYEES STATE INSURANCE CORPORATION

    TEMPORARY IDENTITY CERTIFICATE 2


    ONLY FOR FORM FEEDING FOR ONLINE REGISTRATION THIS FORM IS NOT FOR TREATMENT
    Insured Person 0
    Insurance No. 0
    Date of Registration 2/1/2021
    YOUR REGISTRATION DETAILS

    Employee Name: 0 Type of Disability : 0

    Name of Father / Husband Name 0 Date of Birth: 0 0 0

    Marital Status: 0 Gender 0

    Present Address: 0 Permenant Address : 0

    Dispensary / IMP : 0 Local Office 0


    Current Employer Details Previous Employer Details:
    Employer's Code No. : 31 000 12345 000 0123 Employer's Code No. :
    Sub Unit's Code No. Sub Unit's Code No.
    Date of Appointment: 0 0 0 Previous Insurance No. :

    Name of the Employer : XYZ & CO. Name of the Employer : 0

    Address of Employer : ADDRESS Address of Employer :

    Family Details :
    Whether Residing
    Name Relationship with the Employee Date of Birth State District
    with him
    0 0 0/1/1900 0 0/1/1900 0
    0 0 0/1/1900 0 0/1/1900 0
    0 0 0/1/1900 0 0/1/1900 0
    0 0 0/1/1900 0 0/1/1900 0
    0 0 0/1/1900 0 0/1/1900 0
    0 0 0/1/1900 0 0/1/1900 0
    Nominee Details:
    Name of Nominee Relationship with IP Percentage Address of Nominee
    0 0 100% 0
    Details of Bank :
    Type of
    Account No. Name of Bank Branch Micr Code of Bank IFSC Code No.
    Account

    0 0/1/1900 0 0 0 0

    Documents Uplodaed:
    Please Verify the above particulars.
    Please Notify Your Employer or in the Brnach 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 in the mentioned BRANCH Office: 0
    Signature / LTI of Registered Employee / IP :

    Mobile No. 0
    Contact of Home 0

    You might also like