EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : AVINASH SHIVAJI BARGE Insurance No. : 2504177157

Date of Birth : 05/09/1998 UHID : MH01.0011095988
Gender : Male UAN : NA
Mobile Number : 7020776632 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 16/06/2021 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : SHIVAJI

Husband
Type Of Disability : NA
Present Address : AT.WALUJ,Dist:Chhatrapati Permanent Address : AT.WALUJ,Dist:Chhatrapati
Sambhajinagar,Maharashtra Sambhajinagar,Maharashtra

Dispensary / : DCBO - WALUJ Dispensary / : DCBO - WALUJ

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 25000067530001001 Name of Employer : K. D. MANPOWER SERVICES

No. PVT. LTD.,

Sub Unit's Code : None Date of : 16/06/2021

No. Appointment

Address of : C/O. D.N.SHELAR,,RM-206/02, BAJAJ Branch Office : DCBO - WALUJ,Plot no P173,

Employer NAGAR,,MIDC, WALUJ, Opp Tirupati Hospital, Mahavir
chowk, MIDC,NA Waluj,

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

Maharashtra /
SAMARTH Minor 18/03/2022 NA Yes
AVINASH BARGE dependant son
Chhatrapati Sambhajinagar

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 Maharashtra /
KALAVATI Spouse 23/02/2005 NA Yes
AVINASH BARGE
Chhatrapati Sambhajinagar

NOMINEE DETAILS

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

SAME AS
SHIVAJI Dependant father NA NA ABOV,MaharashtraDist:Chh 100
atrapati Sambhajinagar

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) : K. D. MANPOWER SERVICES PVT. LTD.,

IP Number : 2504177157
Address : AT.WALUJ,Dist:Chhatrapati Sambhajinagar,Maharashtra

Date : 15/03/2024 7:00:21PM

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