EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : PRATHAM BANSAL Insurance No. : 6722730419

Date of Birth : 19/08/2004 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8265931891 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 25/10/2023 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : Vijay Bansal

Husband
Type Of Disability : NA
Present Address : 448/4 Shastri Nagar Sector - 4 Meerut Pin Permanent Address : 448/4 Shastri Nagar Sector - 4
250001,Dist:Meerut,Uttar Pradesh Meerut Pin
250001,Dist:Meerut,Uttar
Pradesh
Dispensary / : Shantinagar, Meerut, UP (ESIS Disp.) Dispensary / : Shantinagar, Meerut, UP (ESIS
IMP for IP IMP for Family Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 67000638550000999 Name of Employer : PSH INFRA TECH

No.

Sub Unit's Code : None Date of : 20/10/2023

No. Appointment

Address of : Shop No.66,Virandavan Branch Office : BO - Ghaziabad,GHAZIABAD

Employer Garden,Sahibabad,Ghaziabad,Uttar Branch Office, ESI Corporation,
Navyug , 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 /
Seema Bansal Dependant 02/01/1977 NA No
mother
Meerut

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 Uttar Pradesh /
VIJAY BANSAL Dependant 02/01/1972 NA No
father
Meerut

NOMINEE DETAILS

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

448/4 Shastri Nagar Sector -

Vijay Bansal Dependant father NA NA 4 Meerut Pin 250001,Uttar 100
PradeshDist:Meerut

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) : PSH INFRA TECH

IP Number : 6722730419
Address : 448/4 Shastri Nagar Sector - 4 Meerut Pin 250001,Dist:Meerut,Uttar Pradesh

Date : 20/05/2024 5:14:11PM

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