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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.





Employees'   State Insurance (General) Regulations, 1950 Back






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