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    Temporary Identity Certificate

    Uploaded by

    Suman
    This document is a temporary identity certificate from the Employees State Insurance Corporation for Bhavani Nagalla with insurance number 5209363347. It provides her registration details including personal information like name, father's name, date of birth, address, employer details, and nominee details. It requests that she visit the branch office by October 2nd, 2012 to get her biometric and photo captured to receive a permanent ID card.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Temporary Identity Certificate

    Uploaded by

    Suman
    87K views1 page
    This document is a temporary identity certificate from the Employees State Insurance Corporation for Bhavani Nagalla with insurance number 5209363347. It provides her registration details including personal information like name, father's name, date of birth, address, employer details, and nominee details. It requests that she visit the branch office by October 2nd, 2012 to get her biometric and photo captured to receive a permanent ID card.

    Original Title

    TEMPORARY IDENTITY CERTIFICATE

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    © Attribution Non-Commercial (BY-NC)

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    This document is a temporary identity certificate from the Employees State Insurance Corporation for Bhavani Nagalla with insurance number 5209363347. It provides her registration details including personal information like name, father's name, date of birth, address, employer details, and nominee details. It requests that she visit the branch office by October 2nd, 2012 to get her biometric and photo captured to receive a permanent ID card.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    87K views1 page

    Temporary Identity Certificate

    Uploaded by

    Suman
    This document is a temporary identity certificate from the Employees State Insurance Corporation for Bhavani Nagalla with insurance number 5209363347. It provides her registration details including personal information like name, father's name, date of birth, address, employer details, and nominee details. It requests that she visit the branch office by October 2nd, 2012 to get her biometric and photo captured to receive a permanent ID card.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE

    Insured Person : Bhavani Nagalla Insurance No : 5209363347 Date of Registration :17/09/2012

    YOUR REGISTRATION DETAILS


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

    Bhavani Nagalla N.VENKATESWARA RAO Unmarried Bhavani Nagalla,D.No. 6-51,S.E.R CENTER,VIJAYAWADA,Dist:Krishna,Andhra Pradesh,520118 None

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

    None 26/01/1989 F Bhavani Nagalla,D.No. 6-51,S.E.R CENTER,VIJAYAWADA,Dist:Krishna,Andhra Pradesh,520118

    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

    52000170240000911 None 02/08/2012 Ananth Technologies Ltd Plot No.39,ANANTH INFO PARK, HI-TEC CITY, PHASE-II,MADHAPUR,Dist:HyderabadAndh ra Pradesh500081
    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

    ---

    ---

    ---

    ---

    ---

    ---

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

    N.VENKATESWARA RAO

    Dependant father

    100

    ECR CENTRE,Prasadampadu,Vijayawada,Andhra PradeshDist:Krishna

    Documents Uploaded:
    none

    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 02/10/2012 , in the Below Branch Office : BO- Sanathnagar,Plot.No.54/A,Sundernagar Model Colony,Erragadda, Hyderabad.500 038 Tel. 04023701714, 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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