Scribd Logo
Upload

Welcome to Scribd!

  • 25 views

    Esic Medical Card

    Uploaded by

    billaraj790
    Medical insurance

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Esic Medical Card

    Uploaded by

    billaraj790
    25 views1 page
    Medical insurance

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Medical insurance

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    25 views1 page

    Esic Medical Card

    Uploaded by

    billaraj790
    Medical insurance

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    H.P. Cal.

    -6/92/1,00,000 ESIC-MED-7B

    MEDICAL ACCEPTANCE CARD

    GOWTHAM
    Full Name ...................................................................................................................
    KARTHIKAYEN
    Father or Husband's Name .......................................................................................

    QUESS CORP LIMITED


    Factory Name .............................................................................................................

    Present Residential address

    Tamilnadu,Dist:Chennai,Tamilnadu,,

    Ins. No./
    5135596032
    Ref. No.

    EMPLOYEES' STATE INSURANCE CORPORATION

    I apply to be included in the list of Dr.........................................................


    I declare that I am not already in the list of a doctor in this or any other
    area.

    Signature or thumb impression of


    Date............................
    Insured Person

    To be completed by Doctor: Doctor's


    Code No.

    I accept this person for inclusion in my list

    Date: Signature of the Doctor.

    You might also like