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Annexure I Employees' FORM: PE-01 Old-Age Benefits (Revised) Institution Application For Employee'S Registration
Annexure I Employees' FORM: PE-01 Old-Age Benefits (Revised) Institution Application For Employee'S Registration
FORM: PE-01
(Revised)
EMPLOYEES
OLD-AGE BENEFITS
INSTITUTION
APPLICATION FOR EMPLOYEES REGISTRATION
1
Gender
2A
Handicapped
yes
No
2B
Nature of Disability*
(Only if 2A is
Checked as Yes)
Visual
Hearing
Male
Female
Speaking
Limbs
Other
(Please specify)
Date of Birth
In words
National Identity Card No.
F
Year
5A
5B
Family Code
Present
Address
Permanent
Address
CERTIFICATE OF EMPLOYER
Day Month
Year
10
Name of establishment
Workers Signature
Registration No.
Seal of the
Establishment
Signature of Employer
Name
Designation
Day Month
Year
Date
FOR OFFICE USE ONLY
EOBI Registration Card No.
Initial
Day Month
Year
Day Month
Year