lL Name FORM XXXII [See Rule 272(7)] APPLICATION FOR DUPLICATE CARD Wmanupatra®PART IFA] RULES ANDNOTIFICATIONS—CHHATTISGARH GOVERNMENT Wimanv patra® ra’ 2, Name of Father/Husband 3. Male/Female 4, Address () Current Address (2) Permanent Address : Whether SC/ST + Yes/No Marital status (Married/Unmarried/ Widow Date of Birth . Name, Address & Registration No. of the establishment where applicant is working 9. Name and address of employer 10, Nature of Job/Employer waa 1. ESV/EPF No. 12. Date since when working for current employer 13. Registration No. as beneficiary 14. Office Board where registered as beneficiary 15. Rate of monthly contribution 16. Month upto which contribution paid 17. Reason for requesting issue of duplicate Identity card “The above facts are true to the best of my knowledge and belief. ‘My original Identity Card is being surrendered herewith. ‘Two passport size photographs are enclosed : (where applicable) Place = Signature of applicant Dat