The Code on Social Security (Arunachal Pradesh) Rules, 2021
Form XXIII
Official text
Open in the official PDF (p. 59)
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[See Rule 61(4)]
OPTION TO CONTINUE UNDER THE EXISTING INSURANCE UNDER SECTION 57
I, hereby opt to continue the existing insurance scheme in lieu of the compulsory insurance
notified under Section 57 of the Code on Social Security, 2020. The details of existing Insurance
Scheme are—
(a) No. of Insurance Policy :
(b) Date of commencement of Insurance Policy :
(c) Terms and conditions of Insurance Policy (Copy of the Insurance Policy to be enclosed) :
(d) No. of employees covered (details of employees to be furnished in Form-XXII :
(e) Details of registration of the trust :
(f) Name and address of the trustees :
Place :
Date : Signature of the Employer
Name & Designation and Address