Insurance No. : 6634155702 Date of Registration : 27/12/2024 Medical Acceptance Card [Click Here to View Medical Acceptance Card] YOUR REGISTRATION DETAILS Please seed Universal Account Number (UAN) Employee Name: BRJESH KUMAR Type of Disability: NA Name of Father / sahaj ram Date of Birth: 01/01/1997 Husband: Marital Status: Unmarried Gender: Male jamdan,Dist:Bahraich,Uttar Present Address: muthiahpuram,Dist:Thoothukudi,Tamilnadu,628005 Permanent Address: Pradesh,271803 Dispensary / IMP for Dispensary / IMP for IP: Tuticorin, TN (ESIS Disp.) Tuticorin, TN (ESIS Disp.) Family: UHID: DL01.0007381525 ABHA Number: NA UAN: NA EmailID: NA ABHA Address: NA Aadhaar: NA Employer's Code No.: 66000465780001020 Employer's Code No.: None Sub Unit's Code No.: None Sub Unit's Code No.: None Date of Appointment: 27/12/2024 First Insurance No.: None Name of Employer: RR.VASIKARAN AND COMPANY Name of Employer: None 3/128 B-26,Perinba Address of Employer: Address of Employer: None Nagar,Muthiahpuram,Dist:ThoothukudiTamilnadu628005
Family Details
Relationship with UHID/ABHA ABHA Whether Residing Place of
Name Date of Birth UAN/Adhaar the Employee Number Address with IP Residence State District --- --- --- --- --- --- --- --- Nominee Details Percentage Name of Nominee Relationship with IP Date of Birth UHID/ABHA Number Address of Nominee Allotted jamdan,Uttar sahaj ram Dependant father NA NA 100 PradeshDist:Bahraich271803 Documents none Uploaded:
BO - Tuticorin,ESI Corporation Branch Office,No. 164-N, North Beach Road, Tuticorin – 628 001,628001 Affix Your Family Photograph Here.(Attested and Stamped by Employer / Signature / ESIC Official) LTI of Registered Employee / IP :
Mobile No. : 9458465689
NOTE:
1. Please keep this printout for future reference and bring this along with your Photo ID Card for all your claim benefits and medical benefits. 2. This copy should be retained with you until the Pehchan Card is received. 3. Employer to please affix employee and his family photo here and attest with official stamp across.
