EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : VAGHELA ASHOKSINH NATUBHA Insurance No. : 3715078450

Date of Birth : 06/11/1993 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8238712078 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 25/09/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Married Name of Father / : NATUBHA

Husband
Type Of Disability : NA
Present Address : 2-127 vaghelavas gochnad Permanent Address : 2-127 vaghelavas gochnad
patan,Dist:Patan,Gujarat,385340 patan,Dist:Patan,Gujarat,38534
0

Dispensary / : D 1 Gandhinagar, Ahm., GJ (ESIS Disp.) Dispensary / : D 1 Gandhinagar, Ahm., GJ

IMP for IP IMP for Family (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 42000064230001018 Name of Employer : SIS LIMITED

No.

Sub Unit's Code : 37420064230051018 Date of : 23/09/2023

No. Appointment

Address of : SHOP NO 312-315 SWAGAT RAIN Branch Office : BO -

Employer FOREST-2,koba-gandhinagar Gandhinagar,BR.MGR.ESIC
67/8, CH- TYPE, 2ND

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

2-127 vaghelavas gochnad

NATUBHA Dependant father NA NA patan,GujaratDist:Patan3853 100
40

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) : SIS LIMITED

IP Number : 3715078450
Address : 2-127 vaghelavas gochnad patan,Dist:Patan,Gujarat,385340

Date : 25/09/2023 11:05:51AM

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