EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : RAHUL Insurance No. : 1326313540

Date of Birth : 01/01/2005 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8368606050 ABHA Number : NA
Email ID : rahulrajkumarraj409@gmail.com ABHA Address : NA
Registration Date : 16/02/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : DHANGI PARSHAD

Husband
Type Of Disability : NA
Present Address : HOUSE NO: 429, KHAND B, JAWAHAR Permanent Address : HOUSE NO: 429, KHAND B,
COLONY, FARIDABAD,SECTOR-22, JAWAHAR COLONY,
FARIDABAD,,HARYANA,Dist:Faridabad,H FARIDABAD,SECTOR-22,
aryana,121005 FARIDABAD,,HARYANA,Dist:F
Dispensary / : D 6 Jawahar Colony, HR (ESIS Disp.) Dispensary / : aridabad,Haryana,121005
D 6 Jawahar Colony, HR (ESIS
IMP for IP IMP for Family Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 13000834020000606 Name of Employer : M K ENGINEERING

No.

Sub Unit's Code : None Date of : 12/02/2023

No. Appointment

Address of : PLOT NO.10306,GALI Branch Office : BO - Faridabad,Sector -23,Main

Employer NO.321,SEC.23,FARIDABAD,Dist:Farida Road, Sector-23, Opp. SPL
Company,Faridabad,121004
NA

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

Haryana /
DHANJI Dependant 01/01/1972 NA Yes
PARSHAD father
Faridabad

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 Name Relation Date UHID/ABHA Number ABHA UAN/ Is Residing State/District
with of Birth Address Aadhaar with IP
IP

Haryana /
CHANDAN Others 01/01/2008 NA Yes

Faridabad

Haryana /
BEBI DEVI Dependant 01/01/1974 NA Yes
mother
Faridabad

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 NOMINEE DETAILS

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

JAWAHAR COLONY
BEBI DEVI Dependant mother NA NA NIT,JAWAHAR COLONY 100
NIT,FARIDABAD
HARYANA,HaryanaDist:Fari
dabad121005

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) : M K ENGINEERING

IP Number : 1326313540
Address : HOUSE NO: 429, KHAND B, JAWAHAR COLONY, FARIDABAD,SECTOR-22,
FARIDABAD,,HARYANA,Dist:Faridabad,Haryana,121005
Date : 19/10/2023 1:11:44PM

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