ESI APPLICATION FORM
2
FORM 01(A) E.S.I ANNUAL INFORMATION – EMPLOYEE’S DETAILS: 1) Name and Address of the factory : 2) Employer’s Code number : 56-00- 3) State / district : TAMILNADU / COIMBATORE 4) Nearest police Station : 5) Name of the Town / Revenue Village : 6) Name of Taluk / Tehsil : 7) Hudbast / Revenue Demarcation : 8) Municipality / Ward Number : Coimbatore / Ward No. 9) Phone Number / Mobile number : 10) Fax number : 11) E-mail Address : 12) Bank Details – Bank Name : Bank branch Name : Account Number : MCIR Code of the Bank : IFSC Code of the Bank :
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ESI APPLICATION FORM
Transcript of ESI APPLICATION FORM
FORM 01(A)
E.S.I ANNUAL INFORMATION – EMPLOYEE’S DETAILS:
1) Name and Address of the factory :
2) Employer’s Code number : 56-00-
3) State / district : TAMILNADU / COIMBATORE
4) Nearest police Station :
5) Name of the Town / Revenue Village :
6) Name of Taluk / Tehsil :
7) Hudbast / Revenue Demarcation :
8) Municipality / Ward Number : Coimbatore / Ward No.
9) Phone Number / Mobile number :
10) Fax number :
11) E-mail Address :
12) Bank Details – Bank Name :
Bank branch Name :
Account Number :
MCIR Code of the Bank :
IFSC Code of the Bank :
13) Principal Employer‘s Name / Age /Designation / Father’s Name and Address :
14) Number of Employees :
15) Name & Address of the responsible Person Particulars / Factory / Offices Phone No. / Mobile / Fax No. / Email:
16) Income Tax pan No./ GIB No./ Ward :17) Power Connection Number :
Power Sanctioned Load / Issue. Auth : /TNEB-CBE
18) Constitution of Ownership : Prop/ Partnership /Pvt/ Pub.
19) Responsibleperson’s Name / Address : as above
20) Any other work thro Contract / Immediate Employer / Branch / Nature Of such work / business :
21) ESI Branch Office / Inspn. Divn : PMDU
