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6935608932

asd esi c

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15 views

6935608932

asd esi c

Uploaded by

ayushgupta141500
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : ABHISHEK KUMAR Insurance No. : 6935608932


Date of Birth : 01/01/2003 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8383976481 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 09/12/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : MUKESH PATEL


Husband
Type Of Disability : NA
Present Address : HARI NAGAR , Permanent Address : S/O MUKESH
SEC-37,Dist:Gurgaon,Haryana PATEL,PHULWARIA
,,Dist:Patna,Bihar

Dispensary / : Sector-37, Gurgaon, HR (ESIS Disp.) Dispensary / : Basai Road,Gurgaon , HR


IMP for IP IMP for Family (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 69000648840000999 Name of Employer : GUPTA SAREES CENTRE


No.

Sub Unit's Code : None Date of : 30/11/2024


No. Appointment

Address of : Dundahera,,Mata Wali Branch Office : BO - Dundahera,H.No. 491


Employer Gali,Gurgaon,Dist:GurgaonHaryana12201 Peepalwali Gali
Dundahera-122001,

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

W/O MUKESH PATEL


GUDIA DEVI Dependant mother NA NA PHULWARIA 100
PATNA,BiharDist:Patna

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) : GUPTA SAREES CENTRE


IP Number : 6935608932
Address : HARI NAGAR , SEC-37,Dist:Gurgaon,Haryana

Date : 09/12/2024 9:32:22PM

Page 2 of 2

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