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    6111976436

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    waytolbsnaa001

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    © All Rights Reserved
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    6111976436

    Uploaded by

    waytolbsnaa001
    4 views2 pages

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    Copyright:

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    4 views2 pages

    6111976436

    Uploaded by

    waytolbsnaa001

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    © All Rights Reserved
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    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : Swati Devi Insurance No. : 6111976436


    Date of Birth : 25/06/2001 UHID : USID.0000005261
    Gender : Female UAN : 101281684242
    Mobile Number : 9012006699 ABHA Number : 67-3461-0040-1063
    Email ID : NA ABHA Address : 67346100401063@abdm
    Registration Date : 21/06/2019 Aadhaar : Verified

    REGISTRATION DETAILS

    Marital Status : Unmarried Name of Father / : Pradeeptiwari


    Husband
    Type Of Disability : NA
    Present Address : RAWALI Permanent Address : RAWALI
    MAHADOOD,BAHADRABAD,Dist:Haridwa MAHADOOD,BAHADRABAD,D
    r,Uttarakhand ist:Haridwar,Uttarakhand

    Dispensary / : Sidcul, UC (ESIS Disp.) Dispensary / : Sidcul, UC (ESIS Disp.)


    IMP for IP IMP for Family

    CURRENT EMPLOYER DETAILS

    Employer's Code : 15000145460001001 Name of Employer : OM ENTERPRISES


    No.

    Sub Unit's Code : 61150145460021001 Date of : 15/06/2019


    No. Appointment

    Address of : A-13,NEW SHOPING Branch Office : BO - Haridwar,BO-Haridwar


    Employer COMPLEX,SHIVALIK NAGAR Gr-II,Quarter No. 1-2, Opp. Khel
    Bhawan, Sector-2,
    NA BHEL,

    FAMILY DETAILS

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


    with of Birth Address Aadhaar with IP
    IP

    Uttarakhand /
    MANJU Dependant 01/01/1975 NA Yes
    mother
    Haridwar

    Page 1 of 2
    NOMINEE DETAILS

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

    SAME,UttarakhandDist:Hari
    PRADEEP TIWARI Dependant father NA NA dwar 100

    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) : OM ENTERPRISES


    IP Number : 6111976436
    Address : RAWALI MAHADOOD,BAHADRABAD,Dist:Haridwar,Uttarakhand

    Date : 02/09/2024 10:19:15AM

    Page 2 of 2

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