EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : SUJIT KUMAR MAHANTA Insurance No. : 4119304397

Date of Birth : 26/04/1996 UHID : NA
Gender : Male UAN : NA
Mobile Number : 9938835763 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 05/12/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : Danardan mahanta

Husband
Type Of Disability : NA
Present Address : Analajodi, Harichandanpur, Permanent Address : Analajodi, Harichandanpur,
keonjhar,Dist:Kendujhar (Keonjhar),Odisha keonjhar,Dist:Kendujhar
(Keonjhar),Odisha

Dispensary / : Duburi, OR (ESIS Disp.) Dispensary / : Duburi, OR (ESIS Disp.)

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 41000723760000999 Name of Employer : Sumcon Infraventures Llp

No.

Sub Unit's Code : None Date of : 01/12/2023

No. Appointment

Address of : Sarvamangala House,Gr Flr R No 10p Branch Office : BO - BELIAGHATA,9, NAFAR

Employer 5,Dr Rajendra Prasad KOLEY ROAD, KOLKATA Â?
700 015,0

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

Analajodi, Harichandanpur,
Danardan mahanta Dependant father NA NA keonjhar,OdishaDist:Kendujh 100
ar (Keonjhar)

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) : Sumcon Infraventures Llp

IP Number : 4119304397
Address : Analajodi, Harichandanpur, keonjhar,Dist:Kendujhar (Keonjhar),Odisha

Date : 05/12/2023 1:55:17PM

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