EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE

Insured Person : Y. Bhaskara Reddy Insurance No : 5210032986 Date of Registration :26/08/2013

YOUR REGISTRATION DETAILS

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

Y. Bhaskara Reddy Y.JAYARANGA REDDY Unmarried G.S.R HOSPITAL, VINAY NAGAR, OPP. GOUTAM MODEL SCH,SAIDABAD,HYDERABAD,Dist:Hyderabad,An Yakuthpura, AP (ESIS Disp.) dhra Pradesh,506331 52000449950001499 None 01/06/2013 HYDERABAD CLEFT SOCIETY #2-2-23/22/29, D.D. COLONY,,BAGHAMBERPET,,HYDERABAD13.,Dist:HyderabadAndhra Pradesh500013
Relationship with the Employe Date of Birth

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

None 01/06/1985 M G.S.R HOSPITAL, VINAY NAGAR, OPP. GOUTAM MODEL SCH,SAIDABAD,HYDERABAD,Dist:Hyderabad ,Andhra Pradesh,506331 None None None None None

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

Family Details:
Name

Whether Residing with I

State

District

Y.JAYARANGA REDDY Y.LAXMI DEVI Y.HANUMANTH REDDY

Dependant father Dependant mother Others

28/11/1966 11/02/1970 15/07/1998

Yes Yes Yes

Andhra Pradesh Andhra Pradesh Andhra Pradesh

Hyderabad Hyderabad Hyderabad

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

Y.JAYARANGA REDDY

Dependant father

100

BEETHAPALLY(V), GOOTY(M),,ANANTHAPUR(D),ANDHRAPRADESH,Andhra PradeshDis

Documents Uploaded:
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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 10/09/2013 , in the Below Branch Office : BO-KOMPALLY,,0 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:

8886554832

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