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    ANIT ESI

    Uploaded by

    silored556

    Copyright:

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

    ANIT ESI

    Uploaded by

    silored556
    1 views2 pages

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    © © All Rights Reserved

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    ANIT ESI

    Uploaded by

    silored556

    Copyright:

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

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : ANIT KUMAR Insurance No. : 1215906236


    Date of Birth : 01/01/2003 UHID : UP01.0008547754
    Gender : Male UAN : NA
    Mobile Number : 7466873245 ABHA : NA
    Email ID : NA PHR Address : NA
    Registration Date : 05/12/2022 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Unmarried Name of Father / : TEJPAL SINGH


    Husband
    Type Of Disability : NA
    Present Address : S/O. TEJPAL SINGH, GANV Permanent Address : S/O. TEJPAL SINGH, GANV
    JAINABAD,,POST. MAHAMADABAD, JAINABAD,,POST.
    HALDAUR, BIJNOR, MAHAMADABAD, HALDAUR,
    CHANDPUR,Dist:Bijnor,Uttar BIJNOR,
    Dispensary / Phase-VII, Mohali, PB (ESIS Disp.)
    : Pradesh,246726 Dispensary / : Phase-VII,
    CHANDPUR,Dist:Bijnor,Uttar
    Mohali, PB (ESIS
    IMP for IP IMP for Family Pradesh,246726
    Disp.)

    CURRENT EMPLOYER DETAILS

    Employer's Code : 12000608750000999 Name of Employer : MANSROVER PRODUCTS


    No. AND SERVICES

    Sub Unit's Code : None Date of : 28/11/2022


    No. Appointment

    Address of : D-41, PHASE-5,MOHALI,Dist:SAS Branch Office : BO - Mohali,Branch Manager,


    Employer NAGAR (MOHALI)Punjab160055 ESI Corporation, ESI Hospital
    Complex, Industrial Area

    FAMILY DETAILS

    Name Relation Date UHID/ABHA PHR UAN/ Is Residing State/District


    with of Birth Address Aadhaar with IP
    IP

    Page 1 of 2
    NOMINEE DETAILS

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

    VILL. GANV
    TEJPAL SINGH Dependant father NA NA JAINABAD,,POST. 100
    MAHAMADABAD,HALDAUR,
    BIJNOR, CHANDPUR,Uttar
    PradeshDist:Bijnor246726

    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) : MANSROVER PRODUCTS AND SERVICES


    IP Number : 1215906236
    Address : S/O. TEJPAL SINGH, GANV JAINABAD,,POST. MAHAMADABAD, HALDAUR,
    BIJNOR, CHANDPUR,Dist:Bijnor,Uttar Pradesh,246726
    Date : 05/12/2022 10:21:03AM

    Page 2 of 2

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