RASHTRIYA ISPAT NIGAM LIMITED
VISAKHAPATNAM STEEL PLANT
VISAKHAPATNAM
!!
"
#
$
%
&' (
Application for Medical Record-cum-Identity Book.
"
$) !*
Through Controlling Officer (with office seal)
+, " (
+ -
Fresh Book / Continuation Book
Name of the Patient
Sex
. /Date of Birth
!
!0
Identification marks
-
!5
6
#
-
Affix
Photograph
here
1.
2.
+%,
Relationship
+
-
)
1Blood Group
(
Present Address
(
Name of the employee
(
2
Employee Number
$
Designation
Department
-
Code :
1
(
! 3
Signature of the Employee
Basic Pay :
-
---------------------------------------------------------------------------------------------------------------------------------------
' (
&
. To be filled by the Personnel Department)
.
4 Regn No.------------------+ 4Book No. ----------------------.
Date of Issue ----------------'
(
(
! 3 Signature of ZPE)