EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : DINESH BHIKAN KHAWALE Insurance No. : 3601277180

Date of Birth : 01/05/2000 UHID : NA
Gender : Male UAN : NA
Mobile Number : 7796488504 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 09/04/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : BHIKAN KHAWALE

Husband
Type Of Disability : NA
Present Address : AMBAD LINK ROAD, GHARKHUL Permanent Address : AMBAD LINK ROAD,
YOJNA, CHUNCHALE,AMBAD, GHARKHUL YOJNA,
NASHIK,Dist:Nashik,Maharashtra CHUNCHALE,AMBAD,
NASHIK,Dist:Nashik,Maharasht
Dispensary / : Ambad, Nasik, MH (ESIS Disp.) Dispensary / : ra
Ambad, Nasik, MH (ESIS
IMP for IP IMP for Family Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 36000351090001001 Name of Employer : BANKAR INDUSTRIAL

No. SERVICES

Sub Unit's Code : None Date of : 31/03/2023

No. Appointment

Address of : 480/29, LAXMI PLAZA,GOLE Branch Office : BO - SATPUR,Pachadeep

Employer COLONY,Dist:NashikMaharashtra422001 Bhavan,Plot No-4 Tribak Road,
Satpur, Nasik - 422007,422007

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

AS
BHIKAN KHAWALE Dependant father NA NA ABOVE,MaharashtraDist:Na 100
shik

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) : BANKAR INDUSTRIAL SERVICES

IP Number : 3601277180
Address : AMBAD LINK ROAD, GHARKHUL YOJNA, CHUNCHALE,AMBAD,
NASHIK,Dist:Nashik,Maharashtra
Date : 09/04/2023 11:37:23PM

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