EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

PERSONAL DETAILS

Name of IP : KARTTIK MINZ Insurance No. : 4403604942

Date of Birth : 02/11/1995 UHID : NA
Gender : Male UAN : NA
Mobile Number : NA ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 25/08/2016 Aadhaar : NA

REGISTRATION DETAILS

Marital Status : Unmarried Name of Father / : JUNAS MINZ

Husband
Type Of Disability : NA
Present Address : RUMABAHAL,LANJIBERNA,Dist:Sundarg Permanent Address : RUMABAHAL,LANJIBERNA,Di
arh (Sundergarh),Odisha st:Sundargarh
(Sundergarh),Odisha

Dispensary / : Rajgangpur, OR (ESIS Disp.) Dispensary / : Rajgangpur, OR (ESIS Disp.)

IMP for IP IMP for Family

CURRENT EMPLOYER DETAILS

Employer's Code : 85000137520001001 Name of Employer : SANJAY KUMAR BINOD

No.

Sub Unit's Code : None Date of : 18/03/2022

No. Appointment

Address of : PLOT NO.969/4421,OCL APPROACH Branch Office : BO - Rajgangpur,Branch Office,

Employer ROAD,RAJGANGPUR. DIST- ESI Corporation, At/PO:
Rajgangpur, Dist:Sundergarh,

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

RUMABAHAL,LANJIBERNA,
JUNAS MINZ Dependant father NA NA OdishaDist:Sundargarh 100
(Sundergarh)

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) : SANJAY KUMAR BINOD

IP Number : 4403604942
Address : RUMABAHAL,LANJIBERNA,Dist:Sundargarh (Sundergarh),Odisha

Date : 08/07/2024 5:47:26PM

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