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Employees' State Insurance Corporation E-Pehchan Card: Personal Details

The document is an e-Pehchan card for Kuldip Kannaujiya, an insured person under the Employees' State Insurance Corporation (ESIC) with insurance number 5136790493. It includes personal details, registration information, current employer details, and family and nominee information. The card serves as proof of registration under the ESI scheme and is required for availing cash and medical benefits.

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14 views2 pages

Employees' State Insurance Corporation E-Pehchan Card: Personal Details

The document is an e-Pehchan card for Kuldip Kannaujiya, an insured person under the Employees' State Insurance Corporation (ESIC) with insurance number 5136790493. It includes personal details, registration information, current employer details, and family and nominee information. The card serves as proof of registration under the ESI scheme and is required for availing cash and medical benefits.

Uploaded by

akinovah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : KULDIP KANNAUJIYA Insurance No. : 5136790493


Date of Birth : 01/03/2004 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8840617764 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 21/11/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : LAT GHURE KANNAUJIYA


Husband
Type Of Disability : NA
Present Address : UTCL LABOUR Permanent Address : PRABHUPUR,Dist:Chandauli,U
COLONY,Dist:Ariyalur,Tamilnadu ttar Pradesh

Dispensary / : Ariyalur(ESIS Disp) Dispensary / : Mobile-A, Aishbagh, Lucknow,


IMP for IP IMP for Family UP (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 35000316590001099 Name of Employer : LIZMONTAGENS INDIA


No. PRIVATE LIMITED

Sub Unit's Code : 51350316590011099 Date of : 21/11/2024


No. Appointment

Address of : LIZMONTAGENS INDIA PVT LTD,C/O. Branch Office : BO - Vellore


Employer CHENNAI PETROLEUM CORPORATION (Kanchipuram),E.S.I.Corporatio
n, No.13, IIIrd Cross Street,

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

PRABHUPUR,Uttar
BRINDA DEVI Dependant mother NA NA PradeshDist:Chandauli 100

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) : LIZMONTAGENS INDIA PRIVATE LIMITED


IP Number : 5136790493
Address : UTCL LABOUR COLONY,Dist:Ariyalur,Tamilnadu

Date : 21/11/2024 7:50:51AM

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