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    Employees' State Insurance Corporation E-Pehchan Card: Personal Details

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    vinodiipm

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Employees' State Insurance Corporation E-Pehchan Card: Personal Details

    Uploaded by

    vinodiipm
    49 views2 pages

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    49 views2 pages

    Employees' State Insurance Corporation E-Pehchan Card: Personal Details

    Uploaded by

    vinodiipm

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : NURAALM Insurance No. : 1511125562


    Date of Birth : 07/04/2002 UHID : RJ01.0002429295
    Gender : Male UAN : NA
    Mobile Number : 8999145985 ABHA : NA
    Email ID : NA PHR Address : NA
    Registration Date : 09/12/2020 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Unmarried Name of Father / : KARAMAT ANSARI


    Husband
    Type Of Disability : NA
    Present Address : KHUSHKHERA,TAPUKARA,Dist:Alwar,Ra Permanent Address : KHUSHKHERA,TAPUKARA,Dist
    jasthan :Alwar,Rajasthan

    Dispensary / : Khushkera, RJ (ESIC Disp.) Dispensary /


    : Khushkera, RJ (ESIC Disp.)
    IMP for IP IMP for Family

    CURRENT EMPLOYER DETAILS

    Employer's Code : 15000510200001099 Name of Employer : D B ENGINEERING &


    No. LOGISTICS

    Sub Unit's Code : None Date of : 12/10/2022


    No. Appointment

    Address of : OPPOSITE SHRI Branch Office : BO - Bhiwadi,Panchdeep


    Employer CEMENT,KHUSHKHERA,BHIWADI,Dist:A Bhawan, Phull Bagh, ,
    lwarRajasthan301707

    FAMILY DETAILS

    Relation
    Date UAN/
    Name with UHID/ABHA PHR Address State/District
    of Birth Aadhaar
    IP

    Page 1 of 2
    NOMINEE DETAILS

    UHID/
    Name of Nominee Relation with IP Date of Birth Address of Nominee Percentage(%)
    ABHA

    khushkhera,RajasthanDist:Al
    KARAMAT ANSARI Dependant father NA NA war 100

    Affix Your Family Photograph Here. (Attested and Stamped by


    Employer / ESIC Official)

    Signature / LTI of Registered Employee / IP

    Signature / Stamp of ESIC Officer / Employer

    Note:
    · This e-Pehchan card affixed with photograph of family & duly attested by the Employer/ESIC Staff shall be requested for
    availing cash/medical benefit.
    · e-Pehchan card is a proof of registration under ESI scheme. However eligibility for various benefits depends upon the
    contribution conditions. For further information on eligibility to various Benefits, please visit- www.esic.in

    Printed By (Employer/User Name) : D B ENGINEERING & LOGISTICS


    IP Number : 1511125562
    Address : KHUSHKHERA,TAPUKARA,Dist:Alwar,Rajasthan

    Date : 07/11/2022 9:58:55AM

    Page 2 of 2

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