EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : ABHISHEK Insurance No. : 3013672946

Date of Birth : 29/10/2000 UHID : NA
Gender : Male UAN : NA
Mobile Number : 9336016904 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 14/03/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : HARIHAR NATH

Husband
Type Of Disability : NA
Present Address : S/O HARIHAR NATH RAIPO REOTIPUR, Permanent Address : S/O HARIHAR NATH RAIPO
DIST. GHAZIPURUTT,Dist:Ghazipur,Uttar REOTIPUR, DIST.
Pradesh,232328 GHAZIPURUTT,Dist:Ghazipur,U
ttar Pradesh,232328
Dispensary / : Mobile-A, Aishbagh, Lucknow, UP (ESIS Dispensary / : Mobile-A, Aishbagh, Lucknow,
IMP for IP Disp.) IMP for Family UP (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 51000037490000305 Name of Employer : MS T T K HEALTHCARE

No. LIMITED

Sub Unit's Code : 30510037490010305 Date of : 06/03/2024

No. Appointment

Address of : 5 GULZAR COLONY,NEW BERRY Branch Office : BO - Bareilly,ESI Hospital

Employer ROAD,,LUCKNOW,Dist:LucknowUttar Campus Sleeper Road, C.B.
Ganj, Bareilly-243502,0
NA

FAMILY DETAILS

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

with of Birth Address Aadhaar with IP
IP

Uttar Pradesh /
HARIHAR NATH Dependant 13/05/1982 NA Yes
father
Ghazipur

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 Uttar Pradesh /
MADHU Dependant 20/12/1984 NA Yes
mother
Ghazipur

NOMINEE DETAILS

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

S/O HARIHAR NATH RAIPO

MADHU Dependant mother NA NA REOTIPUR, DIST. 100
GHAZIPURUTTARPRADESH
,Uttar
PradeshDist:Ghazipur23232
8

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) : MS T T K HEALTHCARE LIMITED

IP Number : 3013672946
Address : S/O HARIHAR NATH RAIPO REOTIPUR, DIST.
GHAZIPURUTT,Dist:Ghazipur,Uttar Pradesh,232328
Date : 14/03/2024 1:02:23PM

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