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

    Uploaded by

    crmgroups1986
    industry health card

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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

    crmgroups1986
    17 views2 pages
    industry health card

    Original Title

    7342780042

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    © © All Rights Reserved

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    industry health card

    Copyright:

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

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

    Uploaded by

    crmgroups1986
    industry health card

    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 : S. R SHRUTHI Insurance No. : 7342780042


    Date of Birth : 14/08/1998 UHID : NA
    Gender : Male UAN : NA
    Mobile Number : 8453250443 ABHA Number : NA
    Email ID : NA ABHA Address : NA
    Registration Date : 27/01/2019 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Married Name of Father / : RAVIKUMAR


    Husband
    Type Of Disability : NA
    Present Address : D/O RAVIKUMAR,SARVE KOPPALU Permanent Address : D/O RAVIKUMAR,SARVE
    BANAVARA,ARSIKERE HASAN KOPPALU
    573103,Dist:Hassan,Karnataka,573103 BANAVARA,ARSIKERE
    HASAN
    Dispensary / : Hassan, KA (ESIS Disp.) Dispensary / : Hassan, KA (ESIS Disp.)
    573103,Dist:Hassan,Karnataka,
    IMP for IP IMP for Family 573103

    CURRENT EMPLOYER DETAILS

    Employer's Code : 49000368900001019 Name of Employer : CRM GROUPS


    No.

    Sub Unit's Code : None Date of : 05/08/2024


    No. Appointment

    Address of : 134/34, CHAMUNDIPURA, 8th A Branch Office : BO - Peenya-I,Peenya-I, No.92,


    Employer CROSS,,NEAR MANJUNATHA PARK, 6th Main Road, Near State
    Bank of Mysore, III Phase,

    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
    RANGASWAMY Spouse NA NA ABOVE,KarnatakaDist:Hass 100
    an573103

    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) : CRM GROUPS


    IP Number : 7342780042
    Address : D/O RAVIKUMAR,SARVE KOPPALU BANAVARA,ARSIKERE HASAN
    573103,Dist:Hassan,Karnataka,573103
    Date : 06/08/2024 1:41:29PM

    Page 2 of 2

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