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  • 3705745657

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    ranjan_va
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    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Sureshbhai Rathod Insurance No : 3705745657 Date of Registration : 19 / 04 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender : Permanent Address

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    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Sureshbhai Rathod Insurance No : 3705745657 Date of Registration : 19 / 04 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender : Permanent Address

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    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
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    56 vizualizări2 pagini

    3705745657

    Încărcat de

    ranjan_va
    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Sureshbhai Rathod Insurance No : 3705745657 Date of Registration : 19 / 04 / 2011 YOUR REGISTRATION DETAILS Employee Name : Name of Father / Husband: Marital Status : Present Address : Type of Disability : Date of Birth : Gender : Permanent Address

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 2

    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE

    Insured Person : Sureshbhai Rathod Insurance No : 3705745657 Date of Registration :19/04/2011

    YOUR REGISTRATION DETAILS


    Employee Name : Name of Father / Husband: Marital Status : Present Address :

    Sureshbhai Rathod SOMABHAI RATHOD Married VIJAYNAGAR, HOUSESINGH SOCIETY, KAKARIYA ROAD, Ahmedabad, Gujrat, 380008 D 37/40 KANKARIA AHMEDABAD

    Type of Disability : Date of Birth : Gender : Permanent Address :

    None 26/06/1978 M 1003 A VIJAY NAGAR, HOUSESINGH SOCIETY, KAKARIYA ROAD, Ahmedabad, Gujrat, 380008

    Dispensary / IMP : Current Employer Details Employer's Code No. : Sub Unit's Code No. : Date of Appointment : Name of Employer : Address of Employer :

    Previous Employer Details

    37000263330000199 None 08/04/2010 MS NANDAN EXIM LTD SURVEJ NO.198/1,SAIJPUR GOPALPUR PIRANA ROAD ,PIPLAJ, Ahmedabad, Gujrat, 382405
    Relationship with the Employe Date of Birth

    Employer's Code No. : Sub Unit's Code No. : Previous Insurance No. : Name of Employer : Address of Employer :

    None None None None None

    Family Details:
    Name

    Whether Residing with I

    State

    District

    SOMABHAI KESHAR BEN NARMADA BEN TWINKALBEL KAJAL KAUSHAL RAJ HARSH RAJ

    Dependant father Dependant mother Spouse Dependant infirm son Dependant infirm son Dependant infirm son Dependant infirm son

    25/02/1935 02/06/1940 08/05/1970 25/08/1988 20/08/1989 21/05/1993 28/04/1994

    No No No No No Yes Yes

    Gujrat Gujrat Gujrat Gujrat Gujrat Gujrat Gujrat

    Ahmedabad Ahmedabad Ahmedabad Ahmedabad Ahmedabad Ahmedabad Ahmedabad

    Name

    Relationship with the Employe

    Date of Birth

    Whether Residing with I

    State

    District

    Nominee Details:
    Name of Nominee Relationship with IP Percentage Address of Nominee

    NARMADABEN

    Spouse

    100

    1003 A VIJAY NAGAR, KAKARIYA ROAD, AHMEDABAD, Ahmedabad, Gujrat, 380008

    Documents Uploaded: Please Verify the Above Particulars. Please Notify Your Employer or in the Branch 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 04/05/2011 , in the Below Branch Office : BO-ISANPUR BO-ISANPUR BR.MGR.ESIC Nr. Akaran Estae, Avtar Hotel,N.H.No.8, Isanpur,Ahmedabad-382443 382443 or any nearest ESIC Bio-metric Camp Locations.
    Signature / LTI of Registered Employee / IP : Affix Your Family Photograph Here.(Attested and Stamped by Employer / ESIC Official)

    Mobile Number :
    NOTE:

    1. Please Keep this Printout for Future Reference and Bring this Along with Your Photo ID Card for All Your Claim Benefits and Medical Benefits . 2. This Copy Should be Retained with You until the Biometric Card is Dispatched . 3. Employer to please affix employee and his family photo here and attest with official stamp across . Signature / Stamp of ESIC Officer / Employer

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