EMPLOYEES STATE INSURANCE CORPORATION
TEMPORARY IDENTITY CERTIFICATE
Insured Person : Jayashree
Insurance No : 5122030787
Date of Registration :07/12/2012

YOUR REGISTRATION DETAILS
Employee Name :

Jayashree

Type of Disability :

None

Name of Father / Husband:

KARUNANIDHI

Date of Birth :

08/08/1990

Marital Status :

Unmarried

Gender :

F

Present Address :

NO 17/ 9 THIRUVENGADEM STREET,WEST
MAMBALAM
CHENNAI,Dist:Chennai,Tamilnadu,600033
None

Permanent Address

Dispensary / IMP :

:

Current Employer Details

NO 17/ 9 THIRUVENGADEM STREET,WEST
MAMBALAM
CHENNAI,Dist:Chennai,Tamilnadu,600033

Previous Employer Details

Employer's Code No. :

51000916550000911

Employer's Code No. :

None

Sub Unit's Code No. :

None

Sub Unit's Code No. :

None

Date of Appointment :

07/11/2012

Previous Insurance No. :

None

Name of Employer :

None

SYSTEMS TECHNOLOGY GROUP (INDIA)
PRIVATE LIMITED
801, A North, 8th Floor, Tidel Park,,No.4,
Canal Bank Road,,Taramani,
Chennai,Dist:ChennaiTamilnadu600 113

Name of Employer :
Address of Employer :

Family Details:
Name

Relationship with the Employe

---

---

Date of Birth

---

None

Address of Employer :

Whether Residing with I

---

State

---

District

---

Nominee Details:
Name of Nominee

KARUNANIDHI

Relationship with IP

Dependant father

Percentage

100

Address of Nominee

NO 17/ 9 THIRUVENGADEM STREET,WEST MAMBALAM CHENNAI,TamilnaduDist:Chenna

Documents Uploaded:
none

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
22/12/2012 , in the Below Branch Office : BO-Adayar,No. 112 Thiruvalluvar Salai, II Floor, Shree Venkateswara Complex,
Thiruvanmiyur, Chennai ,600041 or any nearest ESIC Bio-metric Camp Locations.
Signature / LTI of Registered Employee / IP :

Mobile Number :

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

7845739974

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