EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : ABHAY PRATAP SINGH Insurance No. : 3715081229

Date of Birth : 24/10/1998 UHID : NA
Gender : Male UAN : NA
Mobile Number : 9621909899 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 26/09/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : SHIV PRAKASH SINGH

Husband
Type Of Disability : NA
Present Address : KOBARI KALAN,KORABI,KHURD Permanent Address : KOBARI
UNNAO,,Dist:Unnao,Uttar Pradesh,241504 KALAN,KORABI,KHURD
UNNAO,,Dist:Unnao,Uttar
Pradesh,241504
Dispensary / : D 1 Gandhinagar, Ahm., GJ (ESIS Disp.) Dispensary / : D 1 Gandhinagar, Ahm., GJ
IMP for IP IMP for Family (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 42000064230001018 Name of Employer : SIS LIMITED

No.

Sub Unit's Code : 37420064230051018 Date of : 23/09/2023

No. Appointment

Address of : SHOP NO 312-315 SWAGAT RAIN Branch Office : BO -

Employer FOREST-2,koba-gandhinagar Gandhinagar,BR.MGR.ESIC
67/8, CH- TYPE, 2ND

FAMILY DETAILS

Name Relation Date UHID/ABHA Number ABHA 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 Number

KOBARI
UMA SINGH Dependant mother NA NA KALAN,KORABI,KHURD 100
UNNAO,,Uttar
PradeshDist:Unnao

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) : SIS LIMITED

IP Number : 3715081229
Address : KOBARI KALAN,KORABI,KHURD UNNAO,,Dist:Unnao,Uttar Pradesh,241504

Date : 26/09/2023 3:49:44PM

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