EMPLOYEES’S ASTATE INSURANCE CORPORANCE CORPORATION

PHOTO IDENTY CARD APPLICATION FROM

Insurance No. Employer Code

Name of IP
(In Block Letters)

Father’s/Husband’s

Present
Address

Local Sex Dispensary

Office

Marital Status Date of Birth Age

D D M M Y Y Y Y YEARS
Particular of Employment:
1) Date of Appointment

Whether Employed Department Nature of Work

Directly or Directly Office/ Site / Designation
Through Contractor Workshop

Name of Age of Relation with

Nominee Nominee I.P.

DETAIL OF FAMILY MEMBERS

S. Name of Family Member's Date of Birth Relationship with ADHAR NO
No Insured person

7.

Certified that My Parents are dependent upon me and not getting any wages or pension from
any where

Adhhar number of employees

Mobile number