Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 5 views

    Esictic

    Uploaded by

    Google Google

    Copyright:

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

    Esictic

    Uploaded by

    Google Google
    5 views2 pages

    Original Title

    2165692-esictic

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    5 views2 pages

    Esictic

    Uploaded by

    Google Google

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : SACHIN KUMAR Insurance No. : 6720318886


    Date of Birth : 05/06/1990 UHID : NA
    Gender : Male UAN : 101184775207
    Mobile Number : 8909812208 ABHA : NA
    Email ID : NA PHR Address : NA
    Registration Date : 25/08/2021 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Married Name of Father / : BHOPAL SINGH


    Husband
    Type Of Disability : NA
    Present Address : RAM LILA TILLA GALI 1 MUJJAFFAR Permanent Address : RAM LILA TILLA GALI 1
    NAGAR UP,Dist:Ghaziabad,Uttar MUJJAFFAR NAGAR
    Pradesh,251002 UP,Dist:Ghaziabad,Uttar
    Pradesh,251002
    Dispensary / : Jindalnagar, Ghaziabad, UP (ESIS Disp.) Dispensary /
    : Jindalnagar, Ghaziabad, UP
    IMP for IP IMP for Family
    (ESIS Disp.)

    CURRENT EMPLOYER DETAILS

    Employer's Code : 50000189580001099 Name of Employer : TeamLease Services Ltd


    No.

    Sub Unit's Code : 67500189580021099 Date of : 23/08/2021


    No. Appointment

    Address of : 315 Work Avenue Campus, #77, Ascent Branch Office : BO - Ghaziabad,GHAZIABAD
    Employer Building,,Koramangala Industrial Branch Office, ESI Corporation,
    Layout,,Jyothi Nivas College Navyug ,
    Road,,Dist:BangaloreKarnataka560095

    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

    RAM LILA TILLA GALI 1


    BHOPAL SINGH Dependant father NA NA MUJJAFFAR NAGAR 100
    UP,Uttar
    PradeshDist:Ghaziabad

    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) : TeamLease Services Ltd


    IP Number : 6720318886
    Address : RAM LILA TILLA GALI 1 MUJJAFFAR NAGAR UP,Dist:Ghaziabad,Uttar
    Pradesh,251002
    Date : 25/11/2022 2:58:32PM

    Page 2 of 2

    You might also like