EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : OMPRAKASH VARMA Insurance No. : 1014851070

Date of Birth : 01/01/1990 UHID : NA
Gender : Male UAN : NA
Mobile Number : 9910334488 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 09/10/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Married Name of Father / : DEVTADIN VARMA

Husband
Type Of Disability : NA
Present Address : CHHTARPUR,PRATAPGARH,,Dist:Pratap Permanent Address : CHHTARPUR,PRATAPGARH,,
garh,Uttar Pradesh Dist:Pratapgarh,Uttar Pradesh

Dispensary / : Gajaraula, UP (ESIS Disp.) Dispensary / : Gajaraula, UP (ESIS Disp.)

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 10001204790000999 Name of Employer : P. R. CONTRACTOR SERVICE

No.

Sub Unit's Code : None Date of : 30/09/2023

No. Appointment

Address of : D-484,FIFTH FLOOR,WEST VINOD Branch Office : BO - Shahdara,Type-D, Staff

Employer NAGAR,DELHI,Dist:New Quarters, ESI Dispensary
Complex, Nandnagri (Near DTC

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

CHHTARPUR,PRATAPGAR
DEVTADIN VARMA Dependant father NA NA H,,Uttar 100
PradeshDist:Pratapgarh

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) : P. R. CONTRACTOR SERVICE

IP Number : 1014851070
Address : CHHTARPUR,PRATAPGARH,,Dist:Pratapgarh,Uttar Pradesh

Date : 09/10/2023 9:16:31PM

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