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Wednesday, 01 September 2010 05:30

Download Application Form for Group Insurance Scheme for Handicrafts Artisans

Download forms for state: Puducherry
Form Details
StatePuducherry
DepartmentIndustries and commerce
TitleApplication Form for Group Insurance Scheme for Handicrafts Artisans
LanguageEnglish
Document Size17.4 KB
Text of the PDF document(for quick reference)
GOVERNMENT OF PONDICHERRY DISTRICT INDUSTRIES CENTRE ***** APPLICATION FORM FOR GROUP INSURANCE SCHEME FOR HANDICRAFTS ARTISANS 1. Name of the Artisan : 2. Father/Husband's name : 3. Name of the Crafts : 4. Permanent address : 5. Unit address : 6. Whether belongs to SC/ST : YES/NO 7. Age & date of birth : 8. Permanent Regn. No: &Date : 9. Whether he/she has been trained by DIC : YES/NO ( if so, in which year/ Name of the Master Trainer) 10. Nominee name : 11. Nominee father's name : 12. Nominee address : ..2 - 2 - 13. Nominee date of birth : 14. Nominee present age : 15. Nominee relationship : 16. Whether the Artisan or nominee has already been assisted under the scheme 'Janashree Bima yojana Insurance' : YES/NO scheme of LIC? Place : Signature of the applicant with seal Date : DECLARATION I hereby declare that the information furnished above are true to the best of my knowledge and in case, any false information found in the future, I abide to hold full responsibility. Signature of the applicant with seal. N.B: The application should be accompanied with proof for the items mentioned in the Sl .No: 6,7,8,9, & 13.
Last Updated on Friday, 17 December 2010 05:30
 

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