EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : BHERU SINGH RAJPUT Insurance No. : 3417313704

Date of Birth : 10/11/1999 UHID : NA
Gender : Male UAN : NA
Mobile Number : 7976491698 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 06/03/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : RAN SINGH

Husband
Type Of Disability : NA
Present Address : MOKHAMPURA,RAJSAMAND,RAJASTH Permanent Address : MOKHAMPURA,RAJSAMAND,
AN,313325,Dist:Rajsamand,Rajasthan,313 RAJASTHAN,313325,Dist:Rajs
325 amand,Rajasthan,313325

Dispensary / : Kalyan, MH (ESIS Disp.) Dispensary / : Kalyan, MH (ESIS Disp.)

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 34000606000000999 Name of Employer : MAHARANA GLASS PRIVATE

No. LIMITED

Sub Unit's Code : None Date of : 27/02/2024

No. Appointment

Address of : A/702, VIJAY DRUSHTI REGENCY Branch Office : BO -

Employer CIRCLE,KALYAN, THANE, DA WADI Kalyan,Kalyan,Bhagwandas
Mansion, 1st floor, Shivaji

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

MOKHAMPURA,RAJSAMA
LAXMI BHERU Spouse NA NA ND,RAJASTHAN,313325,Raj 100
RAJPUT asthanDist:Rajsamand31332
5

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) : MAHARANA GLASS PRIVATE LIMITED

IP Number : 3417313704
Address : MOKHAMPURA,RAJSAMAND,RAJASTHAN,313325,Dist:Rajsamand,Rajasthan,3
13325
Date : 06/03/2024 4:37:49PM

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