EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : BALWANT SISNGH Insurance No. : 3305021929

Date of Birth : 01/02/1980 UHID : MH01.0002724929
Gender : Male UAN : 101219786047
Mobile Number : 7774020061 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 09/08/2011 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Married Name of Father / : LALLAN SINGH

Husband
Type Of Disability : NA
Present Address : BEHIND ABB COMPANY, SATPUR Permanent Address : BEHIND ABB COMPANY,
NASHIK,Dist:Nashik,Maharashtra,422007 SATPUR
NASHIK,Dist:Nashik,Maharasht
ra,422007
Dispensary / : Satpur, MH (ESIS Disp.) Dispensary / : None
IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

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

No. SERVICES

Sub Unit's Code : None Date of : 08/04/2023

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

Maharashtra /
SMT. SURMANI Dependant 22/04/1958 MH01.0003980049 / NA NA NA Yes
DEVI mother
Nashik

Page 1 of 3
 Name Relation Date UHID/ABHA Number ABHA UAN/ Is Residing State/District
with of Birth Address Aadhaar with IP
IP

Maharashtra /
LALLANSINGH Dependant 01/09/1955 MH01.0003980046 / NA NA NA Yes
father
Nashik

Maharashtra /
MASTER Dependant son 24/12/2003 MH01.0003980047 / NA NA NA Yes
SATYAM receiving
Nashik
education

Maharashtra /
RANJUDEVI Spouse 02/03/1985 MH01.0003980048 / NA NA NA Yes
SINGH
Nashik

Page 2 of 3
 NOMINEE DETAILS

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

BEHIND ABB
MRS. RANJUDEVI Spouse NA NA COMPANY,SATPUR 100
SINGH NASHIK,MaharashtraDist:Na
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 : 3305021929
Address : BEHIND ABB COMPANY, SATPUR NASHIK,Dist:Nashik,Maharashtra,422007

Date : 16/04/2023 8:09:12PM

Page 3 of 3