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  • Esic Ip Tic Template

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    Pranav Paste
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    This document contains personal and family details of an employee, including their name, date of birth, address, bank account details, nominees, and family member information. Up to 5 family members are listed with their name, date of birth, relationship to the employee, whether they reside with the employee, and their address if not residing. The document collects information needed to process employee benefits and payments.

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    This document contains personal and family details of an employee, including their name, date of birth, address, bank account details, nominees, and family member information. Up to 5 family members are listed with their name, date of birth, relationship to the employee, whether they reside with the employee, and their address if not residing. The document collects information needed to process employee benefits and payments.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views22 pages

    Esic Ip Tic Template

    Uploaded by

    Pranav Paste
    This document contains personal and family details of an employee, including their name, date of birth, address, bank account details, nominees, and family member information. Up to 5 family members are listed with their name, date of birth, relationship to the employee, whether they reside with the employee, and their address if not residing. The document collects information needed to process employee benefits and payments.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 22

    Employee Name as in Employee Name as

    S. No. Emp Code Date of Birth


    Offer Letter in Aadhar card
    Personal Details-
    Marital Status
    Personal Details- (Unmarried / Name of Father / Husband
    Date of Joining
    Gender ( M / F/ Married / Widow / Name
    TG)- Employee Widower)-
    Employee
    Relation(Father / Husband) Present Address Present State Present District
    Present Company
    Present Pin code Present Res.Phone No Present Mobile No
    Email ID
    Permanent Address Permanent State Permanent District Permanent Pin code
    Personal Permanent
    Permanent Res.Phone No Permanent Mobile No
    Email ID
    Nearest ESIC Dispensary
    ESIC Dispensary
    from Employee's Present
    for Family (Parents and Nominee Name
    House (Select the dispansary
    dependants)
    from the Annexure attached)
    Relation Ship with IP ( Spouse / Minor Son /
    Unmarriered Daughter / Son receiving education/
    Infirm son / Infirm unmarried daughter / Father / Address of Nominee Nominee State
    Mother / Brother / Sister / Son receiving
    Education / Others)
    Nominee District Nominee Pin code Nominee Res,Phone No Nominee Mobile No
    Is Nominee a Family Employee's Bank Type Of Account
    Employee's Bank A/C No.
    Member ( Y/N) ( Current / Others / Savings)
    Bank MICR Code of the
    Bank Name Of Branch
    Bank/Branch
    Family -1 Name
    (Dependant-
    Bank IFSC Code of the
    Father/Mother/ Family -1 DOB
    Bank/Branch
    Wife/Son/daught
    er)
    Family -1 Relationship with the Employee
    ( Spouse / Minor Son / Unmarriered Daughter / Son receiving
    education/ Infirm son / Infirm unmarried daughter / Father /
    Mother / Brother / Sister / Son receiving Education / Others)
    Family -2 Name
    Family - 1 Whether residing with
    Family -1 If Family -1 If (Dependant-
    him/ her ?
    No,State No,District Father/Mother/Wif
    (Y / N)
    e/Son/daughter)
    Family -2 Relationship with the Employee
    ( Spouse / Minor Son / Unmarriered Daughter / Son
    Family -2 DOB receiving education/ Infirm son / Infirm unmarried
    daughter / Father / Mother / Brother / Sister / Son
    receiving Education / Others
    Family - 2 Whether residing
    with him/ her ? Family -2 If No,State Family -2 If No,District
    (Y / N)
    Family -3 Name
    (Dependant-Father/Mothe Family -3 DOB
    r/Wife/Son/daughter)
    Family -3 Relationship with the Employee
    Family -3 Whether
    ( Spouse / Minor Son / Unmarriered Daughter /
    residing with him/ Family -3 If
    Son receiving education/ Infirm son / Infirm
    her ? No,State
    unmarried daughter / Father / Mother / Brother /
    (Y / N)
    Sister / Son receiving Education / Others
    Family -4 Name
    Family -3 If (Dependant-Father/M
    Family -4 DOB
    No,District other/Wife/Son/daught
    er)
    Family -4 Relationship with the Employee
    Family -4 Whether
    ( Spouse / Minor Son / Unmarriered Daughter /
    residing with him/ Family -4 If
    Son receiving education/ Infirm son / Infirm
    her ? No,State
    unmarried daughter / Father / Mother / Brother /
    (Y / N)
    Sister / Son receiving Education / Others
    Family -5 Family -5 Relationship with the Employee
    Name(Dependan ( Spouse / Minor Son / Unmarriered Daughter /
    Family -4 If Family -5
    t-Father/Mother/ Son receiving education/ Infirm son / Infirm
    No,District DOB
    Wife/Son/daught unmarried daughter / Father / Mother / Brother /
    er) Sister / Son receiving Education / Others
    Family -5 Whether
    residing with him/ Family -5 If Family -5 If
    her ? No,State No,District
    (Y / N)

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