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jktLFkku ljdkj

jkT; chek ,oa çko/kk;h fuf/k foHkkx] jktLFkku


th , 165 / vkbZ vkj 16
vf/kd ?kks"k.kk&i=
UNIT : RAJSAMAND
Application No: APP20230131570 Application Date: 10/03/2023

1. ,EIy‚bZ vkbZMh : RJRA201131026661

2. iwjk uke : DR BUDH RAM RAJORIA

3. firk dk uke : GIRDHARI LAL KUMHAR

4. fdLe fu;qfDr in : Junior Expert

5. foHkkx : MEDICAL HEALTH & FAMILY WELFARE

6. vi‚baVesaV dh frfFk : 29/12/2011

7. oSokfgd fLFkfr : MARRIED

8. irk : 30 TRIVENI NAGAR ,NEW LOHA MANDI

9. tUe LFkku / tUe

tUe vkxkeh o"kZxkaB ij tUe


10/01/1983 40 KHETRI,JHUNJHNU

10. dVkSrh dk

Basic Pay Deduction Month Current Premium Proposed Premium Increment Premium
93100 01/04/2023 5000 7000 2000

11. D;k vki fodykax ;k us=ghu gSa \ No

12. D;k fuEu ls vkidks dksbZ jksx gqvk

TB Asthma Cancer Diabetes HIV


No No No No No

13. ml euksuhr O;fDr ¼ Nominee ½ dk iwjk fooj.k nhft;s ftldk vki vius ches dh jde dk vf/kdkjh fu;qDr djuk pkgrs gSa / pkgrh gSa |

S.N Relatio 'ks;j laj{kd dk uke] ;fn laj{kd dk laj{kd dh tUe


euksuhr O;fDr dk tUe
. n % ukckfyd Relation
23/12/198
1 PRIYANKA GHATELWAL WIFE 100
7

eSa ?kks"k.kk djrk / djrh gw¡ fd mij fn;s x;s fooj.k lgh lPps gSa vkSj eSaus ,slh dksbZ ckr ugha fNikbZ gS ftlls esjs thou ds ches ij vlj iMs A eSaus Lohdkj / djrh gw¡ fd ;g ?kks"k.kk&i= jktLFkku
chek foHkkx vkSj esjs chp fu;e&i= dk vk/kkj gksxk

eSa bl ches ds laca/k esa jktLFkku ljdkjh deZpkfj;ksa ds jkT; chek fu;e ls gksuk Lohdkj djrk / djrh gw¡ |

Submitted By :- Self

Verified By Aadhar OTP :- 322145

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