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  Details of Insured Persons  




Regional Office



Name& Address of Employer








Dear Sir,

Your organization is registered with EOBI under registration No …………… since. …/…. /… and the Institution has so far received Rs……………/- as contribution from you. While you have paid some contribution, we have not yet received the detail of Insured Persons (i.e. the employees of your organization) as required under Section 11(1) of EOB Act 1976. In the absence of this information, on the one hand the Institution is unable to determine the adequacy of the payment (s) made by you and on the other hand your employees may be deprived of the benefit(s).

 It is therefore, requested to provide the following information within 15 days: 


Sr. No

Old   NIC #

Family Code

EOBI Number (if already registered)

Employee Name


Date of Birth



New NIC #

Father's Name

Date of Joining

For your convenience, a PR-02A form for providing the above information is attached.

We hope that you will provide the above information within the allowed time failing, which we shall be constrained to take the necessary steps as per Rules to obtain the required information.


Yours truly,


                                                                                                   (Regional Head)