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ESIC

New

Uploaded by

hebasurvinod
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : VINOD N HEBASUR Insurance No. : 4941523972


Date of Birth : 29/06/2000 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8494810437 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 26/03/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : NINGANNA


Husband
Type Of Disability : NA
Present Address : CHAKRATH,Dist:Bangalore,Karnataka Permanent Address : CHAKRATH,Dist:Bangalore,Kar
nataka

Dispensary / : Wilson Garden, KA (ESIS Disp.) Dispensary / : Wilson Garden, KA (ESIS


IMP for IP IMP for Family Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 51000892720001002 Name of Employer : Chakrath Career Consultants


No. Private Limited

Sub Unit's Code : 49510892720011002 Date of : 21/03/2024


No. Appointment

Address of : Chakrath Career Consultants Pvt Branch Office : BO -


Employer Ltd.,,No.89, 7th Malleshwaram,Malleswaram,
Opp Mysore Lamp Works,

FAMILY DETAILS

Name Relation Date UHID/ABHA Number ABHA 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 Number

SAME AS
NINGANNA Dependant father NA NA ABOVE,KarnatakaDist:Bang 100
alore

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) : Chakrath Career Consultants Private Limited


IP Number : 4941523972
Address : CHAKRATH,Dist:Bangalore,Karnataka

Date : 03/04/2024 11:11:22AM

Page 2 of 2

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