UNIVERSITY OF DELHI
(Group Insurance Scheme Cell)
Form No. 6203 NEW MEMBERS
Appendix – I
Category __________________
Name of the Institution ______________________________________________________
S.No. Name of the Father’s/ Designation Date of Date of Scale Status Date of Permanent
employee Husband’s Birth Appointment of pay permanent/ Retirement Address
Name against Temporary
substantive
post
___________________________________________________________________________________________________________________
P.T.O.
NB: (1) The proforma has to be prepared separately for Group A, Group B, Group C, Group D employees.
(2) Part-time/adhoc employees, persons on deputation from outside, Research Fellows/employees on compensate ground/in
schemes or casual labourers or on contract basis are not eligible. Their names be not included in this proforma.
(3) Evidence of insurability will be required if the amount of insurance of the member exceeds amout : of ‘No evidence limit’
Granted under the scheme.
EMPLOYER’S CERTIFICATE
Particulars of all our employees eligible to join the Scheme on the effective Date annual/Renewal Date/Accounting Date are given
above. We certify that these particulars are true and correct and request admission of these employees to the Scheme.
We also certify that all the above listed employees.
(a) are members of provident Fund.
(b) Were not absent from work in the ground of ill health on the effected date/annual renewal date/accounting date.
Date _______________________ (Signature on behalf of the employer)
