EMPLOYEES' STATE INSURANCE CORPORATION

TEMPORARY IDENTITY CERTIFICATE

Bidyasagar Show
Insured Person :
4114867946
Insurance No. :
Date of Registration : 15/12/2014

THIS CERTIFICATE IS VALID up to 13/01/2015

YOUR REGISTRATION DETAILS

Employee Name :

Bidyasagar Show

Type of Disability :

None

Name of Father / Husband:

RAMKRIPAL SHOW

Date of Birth :

02/03/1970

Marital Status :

Married

Gender :

Present Address :

5/1 RUSSEL STREET,Dist:Kolkata,West

Bengal,70071

Permanent Address :

FIROJPUR,PO ANDAR
BAZAR,Dist:Siwan,Bihar

None

Dispensary / IMP :

Current Employer Details

First Employer Details

Employer's Code No. :

41000586380001099

Employer's Code No. :

None

Sub Unit's Code No. :

None

Sub Unit's Code No. :

None

Date of Appointment :

01/04/2011

First Insurance No. :

None

Name of Employer :

None

Address of Employer :

None

HASMUKH PAREKH JEWELLERS

Name of Employer :

3A, UPPER WOOD STREET,

KOLKATA-700017.,Dist:KolkataWest
Bengal700017

Address of Employer :

Family Details:
Relationship with the

Name

Employer

Whether Residing

Date of Birth

with Insured Person

State

District

SUSHILA SHOW

Spouse

01/05/1974

Yes

West Bengal

Kolkata

PUJA SHOW

Dependant unmarried daughter

18/05/2001

Yes

West Bengal

Kolkata

MANISH SHOW

Minor dependant son

30/03/2004

Yes

West Bengal

Kolkata

Nominee Details:
Name of Nominee

SUSHILA SHOW

Relationship with IP

Spouse

Percentage

100

Address of Nominee

DO,West BengalDist:Kolkata700071

Documents Uploaded:
none

Please verify the above Particulars.

In case some error is noticed in this TIC please request your employer for correction.
To get permanent ID card, employee is requested to visit the Branch Office or any nearest ESIC Pehchan Camp Location with family, to
get Biometric & Photo captured by 13/01/2015 , on 31st day TIC will become invalid. To revalidate the TIC, please visit the Branch
office or ESIC Pehchan camp immediatley. On enrollment the TIC will become valid upto 90th day from Date of Registration in case
not de-duplicated. In case de-duplication is detected Orginal number will become active & informed to Employer & IP on IP Portal and
the new number de-activated.
Benefit beyond 90th day will be regulated as per the contribution conditions.

Signature / LTI of Registered 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 for all your Claim Benefits and Medical Benefits.
2. This copy should be retained with you until the Pehchan Card is received.
3. Employer to please affix employee and his family photo here and attest with official stamp across .
Signature / Stamp of ESIC Officer / Employer