EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : ZIAUL REHAMAN Insurance No. : 4116575100

Date of Birth : 01/01/1981 UHID : DKDP.0000017648
Gender : Male UAN : NA
Mobile Number : 8420903253 ABHA : NA
Email ID : NA PHR Address : NA
Registration Date : 17/07/2018 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Married Name of Father / : ABDUL ROHIM

Husband
Type Of Disability : NA
Present Address : PAHARPUR, MASJID TALA, MAHESTALA Permanent Address : PAHARPUR, MASJID TALA,
(M),Dist:Kolkata,West Bengal,700066 MAHESTALA
(M),Dist:Kolkata,West
Bengal,700066
Dispensary / : Khiddarpore, WB (ESIS Disp.) Dispensary / : Khiddarpore, WB (ESIS Disp.)
IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 41000607660000999 Name of Employer : PHONEX LOGISTICS PRIVATE

No. LIMITED

Sub Unit's Code : None Date of : 01/04/2018

No. Appointment

Address of : A-1/46/1, PAHARPUR ROAD, P.O. - Branch Office : BO - KIDDERPORE,26, DR.

Employer RABINDRANAGAR,Dist:KolkataWest SUDHIR BOSE ROAD,
KOLKATA Â? 700 023,0

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

West Bengal /
SUMANA BIBI Spouse 25/03/1990 HJOK.0000108996 / NA NA NA Yes

Kolkata

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 Name Relation Date UHID/ABHA PHR UAN/ Is Residing State/District
with of Birth Address Aadhaar with IP
IP

West Bengal /
SIMRAN KHATUN Dependant 27/03/2007 HJOK.0000097893 / NA NA NA Yes
unmarried
Kolkata
daughter

West Bengal /
MUSKHAN Dependant 17/08/2013 HJOK.0000101486 / NA NA NA Yes
KHATUN unmarried
Kolkata
daughter

West Bengal /
SAMANIYA Dependant 28/09/2022 NA / NA NA NA Yes
KHATUM unmarried
Kolkata
daughter

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 NOMINEE DETAILS

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

DO,West
SUMANA BIBI Spouse NA NA BengalDist:Kolkata700066 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) : PHONEX LOGISTICS PRIVATE LIMITED

IP Number : 4116575100
Address : PAHARPUR, MASJID TALA, MAHESTALA (M),Dist:Kolkata,West Bengal,700066

Date : 16/02/2023 1:21:54PM

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