EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : P SRI HARISH KUMAR Insurance No. : 5134873300

Date of Birth : 08/07/2005 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8124328425 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 11/07/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : Ponraj N

Husband
Type Of Disability : NA
Present Address : No.426 Sakthi Nagar 3rd Cross Permanent Address : No.426 Sakthi Nagar 3rd Cross
Street,Poonthandalam,Dist:Chennai,Tamiln Street,Poonthandalam,Dist:Che
adu,600069 nnai,Tamilnadu,600069

Dispensary / : Thirumudivakkam, TN (ESIS Disp.) Dispensary / : Thirumudivakkam, TN (ESIS

IMP for IP IMP for Family Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 51001388520000699 Name of Employer : CONCRETE OEM PRIVATE

No. LIMITED

Sub Unit's Code : None Date of : 10/07/2023

No. Appointment

Address of : Sf No-186 And 188,Erikarai Branch Office : BO - Poonamallee

Employer Road,Kolacherry Village (Kanchipuram),ESI Corporation,
Dhanasu Building,
NA no.l A, Trunk

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

Tamilnadu /
Ponraj N Dependant 20/06/1979 NA Yes
father
Chennai

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 Tamilnadu /
Bhuvaneshwari P Dependant 05/12/1985 NA Yes
mother
Chennai

NOMINEE DETAILS

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

426, Sakthi Nagar 3rd Cross

Ponraj N Dependant father NA NA Street,Poonthandalam,Tamil 100
naduDist:Chennai600069

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) : CONCRETE OEM PRIVATE LIMITED

IP Number : 5134873300
Address : No.426 Sakthi Nagar 3rd Cross
Street,Poonthandalam,Dist:Chennai,Tamilnadu,600069
Date : 11/07/2023 11:21:19AM

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