Temporary Identity Certificate 5y2e1c

EMPLOYEES STATE INSURANCE CORPORATION TEMPORARY IDENTITY CERTIFICATE Insured Person : Bhavani Nagalla Insurance No : 5209363347 Date of Registration :17/09/2012

YOUR REGISTRATION DETAILS Employee Name :

Bhavani Nagalla

Type of Disability :

None

Name of Father / Husband:

N.VENKATESWARA RAO

Date of Birth :

26/01/1989

Marital Status :

Unmarried

Gender :

F

Present Address :

Bhavani Nagalla,D.No. 6-51,S.E.R CENTER,VIJAYAWADA,Dist:Krishna,Andhra Pradesh,520118 None

Permanent Address

Dispensary / IMP :

:

Current Employer Details

Bhavani Nagalla,D.No. 6-51,S.E.R CENTER,VIJAYAWADA,Dist:Krishna,Andhra Pradesh,520118

Previous Employer Details

Employer's Code No. :

52000170240000911

Employer's Code No. :

None

Sub Unit's Code No. :

None

Sub Unit's Code No. :

None

Date of Appointment :

02/08/2012

Previous Insurance No. :

None None

Name of Employer :

Ananth Technologies Ltd

Name of Employer :

Address of Employer :

Plot No.39,ANANTH INFO PARK, HI-TEC CITY, PHASE-II,MADHAPUR,Dist:HyderabadAndh ra Pradesh500081

Address of Employer :

Family Details: Name

Relationship with the Employe

---

---

Date of Birth

---

None

Whether Residing with I

---

State

---

District

---

Nominee Details: Name of Nominee

N.VENKATESWARA RAO

Relationship with IP

Dependant father

Percentage

100

Address of Nominee

ECR CENTRE,Prasadampadu,Vijayawada,Andhra PradeshDist:Krishna

Documents ed: none

Please 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 02/10/2012 , in the Below Branch Office : BO- Sanathnagar,Plot.No.54/A,Sundernagar Model Colony,Erragadda, Hyderabad.500 038 Tel. 04023701714, or any nearest ESIC Bio-metric Camp Locations. Signature / LTI of ed Employee / IP :

Affix Your Family Photograph Here.(Attested and Stamped by Employer / ESIC Official)

Mobile Number : NOTE: 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