EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : FIRDAUS KHAN Insurance No. : 4116579214

Date of Birth : 01/01/1994 UHID : NA
Gender : Male UAN : NA
Mobile Number : NA ABHA : NA
Email ID : NA PHR Address : NA
Registration Date : 20/07/2018 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : FIROZ KHAN

Husband
Type Of Disability : NA
Present Address : R-28, GARDEN REACH Permanent Address : R-28, GARDEN REACH
ROAD,Dist:Kolkata,West Bengal,700024 ROAD,Dist:Kolkata,West
Bengal,700024

Dispensary / : Khiddarpore, WB (ESIS Disp.) Dispensary / : Khiddarpore, WB (ESIS Disp.)

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 41000218930001006 Name of Employer : PHONEX TRADERS PRIVATE

No. LIMITED

Sub Unit's Code : None Date of : 01/04/2019

No. Appointment

Address of : 49/5,CGR RD. DOC BOUNDARY RD. 2 Branch Office : BO - KIDDERPORE,26, DR.
Employer KANTAPUKUR KOLKATA 23,employer 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

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 NOMINEE DETAILS

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

DO,West
FIROZ KHAN Dependant father NA NA BengalDist:Kolkata700024 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 TRADERS PRIVATE LIMITED

IP Number : 4116579214
Address : R-28, GARDEN REACH ROAD,Dist:Kolkata,West Bengal,700024

Date : 16/02/2023 10:30:03AM

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