Biodata Form

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NAME OF THE FACTORY/

ESTABLISHMENT:
Passport photo
Note :- Fill all information in Capital Letters

Mobile No. : Designation :

Name of the Employee : Date of Birth :

Gender : Marital Status :


Father’s Name : Date of Birth :

Mother’s Name : Date of Birth :

Wife/Husband Name : Date of Birth :

Nominee Name(Relation) : Date of Birth :

Son Name
1. Date of Birth :
2. Date of Birth :
3. Date of Birth :
Daughter Name
1. Date of Birth :
2. Date of Birth :
3. Date of Birth :

Present Address :- Vill- PO- PS-


DIST.- STATE- PIN-

Permanent Address :- Vill- PO- PS-


DIST.- STATE- PIN-

Date of Appointment : Gross and Basic Salary : Rs /

Previous Employment Details (If Available):


1. UAN Number : _______________________________ ESIC Number : ____________________________
2. Date of Joining : ______________________________ Date of Exit : _____________________________

Aadhar Number : _____________________________ PAN Number : ____________________________


Bank Account No. _____________________________ IFSC Code : _______________________________

Dispensary Details :
Employee Dispensary : ___________________________ Family Dispensary : ____________________________

Signature of Employer Signature of Employee

*Note : Filling each and every details is compulsory for Registration in EPF and ESIC.

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