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Get India ESIC-MED 37

Fr ds fy, fuosnu djrk gwa fd ftuds lkFk eSa igys gh iathÑr FkkA With reference to certificate of employment on the reverse I apply for acceptance by Dr......................................................................... with whom I was already registered. fnukad--------------------------------- chekafdr O;fDr ds gLrk{kj ;k vaxwBs dk fu'kku Dated Signature or Thumb impression of the insured person eSa bl O;fDr ftldk C;kSjk ihNs fn;k x;k gS fd viuh lwph esa lfEefyr djuk Lohdkj djrk gwaA.

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