EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : SUMAN ROY Insurance No. : 4117427104

Date of Birth : 15/11/1989 UHID : DBRH.0000008418
Gender : Male UAN : NA
Mobile Number : 9831842873 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 18/02/2020 Aadhaar : Verified

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : DIPAK ROY

Husband
Type Of Disability : NA
Present Address : 12/13 Biharilal Pal Street,Kolkata Permanent Address : 12/13 Biharilal Pal
-36,Dist:North 24 Pargana,West Street,Kolkata -36,Dist:North
Bengal,700036 24 Pargana,West
Bengal,700036
Dispensary / : Barahnagar, WB (ESIS Disp.) Dispensary / : Barahnagar, WB (ESIS Disp.)
IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 56001007240001002 Name of Employer : J.G.HOSIERY PVT LTD.

No.

Sub Unit's Code : 41561007240031002 Date of : 09/02/2020

No. Appointment

Address of : 28, B.T.Road,Cossipore, Lohia Branch Office : BO - COSSIPORE,46/1- G,

Employer press,Dist:KolkataWest Bengal700002 B.T. ROAD, KOLKATA Â? 700
002,0 NA

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

West Bengal /
Dipak Roy Dependant 01/10/1961 HKMR.0000027877/ NA Yes
father NA
North 24 Pargana

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 West Bengal /
Shafali Roy Dependant 02/08/1970 NA Yes
mother
North 24 Pargana

NOMINEE DETAILS

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

12/13 Biharilal Pal

DIPAK ROY Dependant father NA NA Street,Kolkata - 100
700036,West
BengalDist:North 24 Pargana

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) : J.G.HOSIERY PVT LTD.

IP Number : 4117427104
Address : 12/13 Biharilal Pal Street,Kolkata -36,Dist:North 24 Pargana,West Bengal,700036

Date : 16/01/2024 12:48:11PM

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