EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : ABHINAV JAIN Insurance No. : 6721944386

Date of Birth : 01/04/2001 UHID : NA
Gender : Male UAN : NA
Mobile Number : 9858711100 ABHA : NA
Email ID : NA PHR Address : NA
Registration Date : 22/02/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : Anil Jain

Husband
Type Of Disability : NA
Present Address : #126/4,GHTP power colony,lehra Permanent Address : #126/4,GHTP power
mohabbatt colony,lehra mohabbatt
dist.bathinda,punjab,Dist:Bathinda,Punjab, dist.bathinda,punjab,Dist:Bathin
151111 da,Punjab,151111
Dispensary / : Mayur Vihar, DL (ESIC Disp.) Dispensary / : Mayur Vihar, DL (ESIC Disp.)
IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 67000365880000606 Name of Employer : PureSoftware Private Limited

No.

Sub Unit's Code : None Date of : 13/02/2023

No. Appointment

Address of : GREEN BLVD PLOT B9-A,3RD FLOOR Branch Office : BO - Noida-I,NOIDA-I,

Employer TOWER B SECTOR-62,NOIDA G B

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

SAME AS
Anil Jain Dependant father NA NA ABOVE,PunjabDist:Bathinda 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) : PureSoftware Private Limited

IP Number : 6721944386
Address : #126/4,GHTP power colony,lehra mohabbatt
dist.bathinda,punjab,Dist:Bathinda,Punjab,151111
Date : 22/02/2023 5:54:38PM

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