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    Fagun

    Uploaded by

    Sk Rakesh

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Fagun

    Uploaded by

    Sk Rakesh
    9 views2 pages

    Original Title

    fagun

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views2 pages

    Fagun

    Uploaded by

    Sk Rakesh

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : FAGUN HEMBROM Insurance No. : 6017498398


    Date of Birth : 25/12/1989 UHID : NA
    Gender : Male UAN : 100674136514
    Mobile Number : 9631855610 ABHA Number : NA
    Email ID : NA ABHA Address : NA
    Registration Date : 05/05/2024 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Married Name of Father / : SULKHU HEMBROM


    Husband
    Type Of Disability : NA
    Present Address : VILL-SITANI, PO- JHALAK,RAJNAGAR Permanent Address : VILL-SITANI, PO-
    JHALAK,RAJNAGAR
    JHARKHAND,831002
    JHARKHAND,831002
    Dispensary / : Sakchi, JH (ESIS Disp.) Dispensary / :
    IMP for IP IMP for Family Sakchi, JH (ESIS Disp.)

    CURRENT EMPLOYER DETAILS

    Employer's Code : 41000355410000699 Name of Employer : HYDROCRAFT ENTERPRISES


    No.

    Sub Unit's Code : None Date of : 03/05/2024


    No. Appointment

    Address of : 93/B,S.A. FAROOQUE ROAD KOLKATA Branch Office : BO - Dassnagar,MAKARDAH


    Employer 700018,Metiabruz,Dist:KolkataWest ROAD, P.O. DASNAGAR,
    DIST - HOWRAH,0

    FAMILY DETAILS

    Name Relation Date UHID/ABHA Number ABHA UAN/ Is Residing State/District


    with of Birth Address Aadhaar with IP
    IP

    Page 1 of 2
    NOMINEE DETAILS

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

    SALKHU HEMBROM Dependant father NA NA SAME,Jharkhand,831002 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) : HYDROCRAFT ENTERPRISES


    IP Number : 6017498398
    Address : VILL-SITANI, POJHALAK,RAJNAGARJHARKHAND,831002

    Date : 05/05/2024 12:21:30AM

    Page 2 of 2

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