e-Pehchan Card

Insured Person : RAVI KUMAR

Insurance No. : 2417477117
Date of Registration : 02/07/2022
Medical Acceptance Card [Click Here to View Medical Acceptance Card]
YOUR REGISTRATION DETAILS
Please seed Universal Account Number (UAN)
Employee Name: RAVI KUMAR Type of Disability: NA
Name of Father / Husband: INDER SAIN Date of Birth: 01/11/1992
Marital Status: Unmarried Gender: Male
Vill jansui (308),jansui,ambala Vill jansui (308),jansui,ambala
Present Address: city,Dist:Ambala,Haryana,134003 Permanent Address: city,Dist:Ambala,Haryana,134003
Dhulkot, Palika Vihar, HR (ESIS
Dispensary / IMP for IP: Dhulkot, Palika Vihar, HR (ESIS Disp.) Dispensary / IMP for Family: Disp.)
UHID: HR01.0009133776 ABHA Number: NA
UAN: NA EmailID: NA
ABHA Address: NA Aadhaar: NA
Employer's Code No.: 24000882220000199 Employer's Code No.: None
Sub Unit's Code No.: None Sub Unit's Code No.: None
Date of Appointment: 19/01/2023 First Insurance No.: None
RAJAN WHOLESALE BAZAAR
Name of Employer: PRIVATE LIMITED Name of Employer: None
NH-01,Kalka Chowk, Vita
Address of Employer: Enclave,Ambala Address of Employer: None
City,Ambala,Dist:AmbalaHaryana134003

Family Details

Relationship with UHID/ABHA ABHA Whether Place of

Name Date of Birth UAN/Aadhaar
the Employee Number Address Residing with IP Residence
State District
SUDESH
Dependant mother 01/01/1972 HR01.0009982429/NA
NA NA Yes Haryana Ambala
RANI
INDAR
Dependant father 01/01/1966 HR01.0009982430/NA
NA NA Yes Haryana Ambala
SAIN
Nominee Details
Percentage
Name of Nominee Relationship with IP Date of Birth UHID/ABHA Number Address of Nominee
Allotted
VILL JANSUI
SUDESH RANI Dependant mother NA NA (308),JANSUI,AMBALA 100
CITY,HaryanaDist:Ambala134003
Documents none
Uploaded:

BO - Ambala,7-8-9, Palika Bazar,Mahesh Nagar,Ambala Cantt. Pin Code:133001,134003

Affix Your Family Photograph Here.(Attested and Stamped by Employer /
ESIC Official)
Signature / LTI of
Registered Employee
/ IP :

Mobile No. :
8168200981

NOTE:

1. Please keep this printout for future reference and bring this along with your Photo ID Card for all your claim benefits and medical benefits.
2. This copy should be retained with you until the Pehchan Card is received.
3. Employer to please affix employee and his family photo here and attest with official stamp across.

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