Employees' State Insurance (General) Regulations, 1950
FORM 4: Identity Card
[Regulations 17]
Insurance No ......................................
|
Name ____________________ Sex ______________________ Son /daughter/ wife of _________ Year of birth ________________ Address __________________ Dispensary ________________ Local office _______________ Prepared by Signature or thumb- impression of the employee |
Identification marks Photograph of the insured person Employment changes Date
Code
No. Date
Code
No. |
