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    Ramjeet Tic

    Uploaded by

    rynplacuutgptzpmge
    ESIC FORMAT

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Ramjeet Tic

    Uploaded by

    rynplacuutgptzpmge
    19 views1 page
    ESIC FORMAT

    Original Title

    RAMJEET TIC

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    ESIC FORMAT

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views1 page

    Ramjeet Tic

    Uploaded by

    rynplacuutgptzpmge
    ESIC FORMAT

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 1

    6/21/24, 7:06 AM CounterFoilPage

    User
    Login: 69000320800001001 Friday, June 21, 2024 7:06:16 AM

    EMPLOYEES' STATE INSURANCE CORPORATION


    e-Pehchan Card

    Insured Person : RAMJEET


    Insurance No. : 6934938056
    Date of Registration : 21/06/2024
    Medical Acceptance Card [Click Here to View Medical Acceptance Card]
    YOUR REGISTRATION DETAILS
    Please seed Universal Account Number (UAN)
    Employee Name: RAMJEET Type of Disability: NA
    Name of Father / Husband: RAKESH KUMAR Date of Birth: 01/01/2001
    Marital Status: Unmarried Gender: Male
    Imt HASANPUR,Dist:Barabanki,Uttar
    Present Address: Manaser,Dist:Gurgaon,Haryana
    Permanent Address: Pradesh
    Dispensary / IMP for IP: Manesar, HR (ESIS Disp.) Dispensary / IMP for Family: Manesar, HR (ESIS Disp.)
    UHID: NA ABHA Number: NA
    UAN: NA EmailID: NA
    ABHA Address: NA Aadhaar: NA
    Employer's Code No.: 69000320800001001 Employer's Code No.: None
    Sub Unit's Code No.: None Sub Unit's Code No.: None
    Date of Appointment: 21/06/2024 First Insurance No.: None
    Name of Employer: KRISHNA ENTERPRISES Name of Employer: None
    H.NO-323 shiv mandir,SECTOR-
    Address of Employer: 22,POCKET- Address of Employer: None
    A,Dist:GurgaonHaryana122016

    Family Details

    Relationship with UHID/ABHA ABHA Whether Place of


    Name Date of Birth UAN/Aadhaar
    the Employee Number Address Residing with IP Residence
    State District
    --- --- --- --- --- --- --- ---
    Nominee Details
    Percentage
    Name of Nominee Relationship with IP Date of Birth UHID/ABHA Number Address of Nominee
    Allotted
    RAKESH KUMAR Dependant father NA NA HASANPUR,Uttar 100
    PradeshDist:Barabanki
    Documents none
    Uploaded:

    BO - Dundahera,H.No. 491 Peepalwali Gali Dundahera-122001,


    Affix Your Family Photograph Here.(Attested and Stamped by Employer /
    ESIC Official)
    Signature / LTI
    of Registered
    Employee / IP :

    Mobile No. :
    9519773381

    NOTE:

    1. Please keep this printout for future reference and bring this along with your Photo ID Card for all your claim benefits and medical benefits.
    2. This copy should be retained with you until the Pehchan Card is received.
    3. Employer to please affix employee and his family photo here and attest with official stamp across.

    Download/Print Close

    DISCLAIMER: Copyright © 2021, ESIC, India. All Rights Reserved. Best viewed in 1024 x 768 pixels, Site maintained by : ESIC. Designed and Developed
    by CMS Computers LTD. IP Address : 16.ASP Session ID : vdl0s245ogpysv55lb1rd0es
    https://www.esic.in/ESICInsurance1/Employee/CounterFoilPage.aspx?empeRegPk=OnbeDjOuIyGF4j8nafyDdA==&emprMasterPk=2ONa6+AG5… 1/1

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