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Employee Edit ESI Details
Personal
ESI
General Details
Working Branch
*
Select Branch
Chennai
Bengaluru
Rajasthan
Gurugram
Goa/Maharashtra
Madhya Pradesh
Odisha
Bihar
Uttar Pradesh
Gujarat
West Bengal
Hyderabad
Jharkhand
Employee Name
*
Employee Code
*
Date of Joining
*
Date of Birth
*
Sex
*
Select
Male
Female
Current Address
Permanent Address
Please tick in case Permanent Address is the same as Current Address
Maritial Status
Select
Married
Single
Personal Mobile No
Personal Email ID
Blood Group
Select
A+
O+
B+
AB+
A-
O-
B-
AB-
PANCARD
ESI Details
Is employee disabled?
Select
Yes
No
If Yes, Type of Disablility
Date of Appointment
Aadhar Number
Relation Details
Relation ship
Name
DOB
Residing Same
House
If No, Mention
State and District
Aadhaar ID
Father
Select
Yes
No
Mother
Select
Yes
No
Spouse
Select
Yes
No
Child-1
Select
Yes
No
Child-2
Select
Yes
No
Child-3
Select
Yes
No
Details of Nominee
Relation ship
Name
Address
Aadhar
Mobile
Whether registered with ESI in previous
(If registered with ESIC in previous employment provide Employer address, Code No. & insurance No )
Employer Address
Employer Code
Insur. No
