EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : SANTOSH S Insurance No. : 5344961233

Date of Birth : 06/01/1990 UHID : NA
Gender : Male UAN : NA
Mobile Number : 7760917173 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 14/05/2017 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : SHARANAPPA

Husband
Type Of Disability : NA
Present Address : GULBARGA,Dist:KALBURGI,Karnataka Permanent Address : GULBARGA,Dist:KALBURGI,K
arnataka

Dispensary / : None Dispensary / : SRO - Bommasandra

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 53000289670001001 Name of Employer : VIMAL ELECTRICALS

No.

Sub Unit's Code : None Date of : 01/04/2017

No. Appointment

Address of : 4TH, 1 B MAIN VI CROSS, Branch Office : BO -

Employer SHIVANAGAR Rajajinagar,Rajajinagar,24/3, Ist
Floor, E Block, Ist Main Road,

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

GULBARGA,KarnatakaDist:
SHARANAPPA Dependant father NA NA KALBURGI 100

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) : VIMAL ELECTRICALS

IP Number : 5344961233
Address : GULBARGA,Dist:KALBURGI,Karnataka

Date : 07/12/2023 1:50:28PM

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