EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : SANTOSH SINGH Insurance No. : 8101517901

Date of Birth : 01/01/1987 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8982365989 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 10/06/2024 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Married Name of Father / : amar singh

Husband
Type Of Disability : NA
Present Address : de,Dist:Satna,Madhya Pradesh Permanent Address : de,Dist:Satna,Madhya Pradesh

Dispensary / : Satna Cement Works, MP (ESIS Disp.) Dispensary / : Satna Cement Works, MP
IMP for IP IMP for Family (ESIS Disp.)

CURRENT EMPLOYER DETAILS

Employer's Code : 59000027910001001 Name of Employer : SHIVA ENGINEERING

No.

Sub Unit's Code : 81590027910011001 Date of : 10/06/2024

No. Appointment

Address of : Guru Kripa House,Gadiya Tola,Post Branch Office : BO - Satna,ESIC Branch

Employer Gabha,Satna,Dist:SatnaMadhya Office, Birla Vikas Nagar,
Satna,MP- 485005,0

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

de,Madhya
de Spouse NA NA PradeshDist:Satna 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) : SHIVA ENGINEERING

IP Number : 8101517901
Address : de,Dist:Satna,Madhya Pradesh

Date : 10/06/2024 6:40:03PM

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