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Monu

The document is a registration detail for an insured person named Monu under the Employees' State Insurance Corporation, with an insurance number of 2113333023. It includes personal information such as date of birth, marital status, address, and employer details, along with nominee information. The document also contains instructions for retaining the printout for future reference and affixing family photographs for identification purposes.

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rishabhsahu87400
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29 views1 page

Monu

The document is a registration detail for an insured person named Monu under the Employees' State Insurance Corporation, with an insurance number of 2113333023. It includes personal information such as date of birth, marital status, address, and employer details, along with nominee information. The document also contains instructions for retaining the printout for future reference and affixing family photographs for identification purposes.

Uploaded by

rishabhsahu87400
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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10/19/24, 11:08 PM CounterFoilPage

User Saturday, October 19, 2024


Login: 21000604500000999 11:08:39 PM

EMPLOYEES' STATE INSURANCE CORPORATION


e-Pehchan Card

Insured Person : MONU


Insurance No. : 2113333023
Date of Registration : 22/08/2024
Medical Acceptance Card [Click Here to View Medical Acceptance Card]
YOUR REGISTRATION DETAILS
Please seed Universal Account Number (UAN)
Employee Name: MONU Type of Disability: NA
Name of Father / Husband: RAM KRISHNA Date of Birth: 01/01/2000
Marital Status: Unmarried Gender: Male
MAHUVARI KHURD,MANDA MAHUVARI KHURD,MANDA
Present Address: KHAS,Dist:Allahabad,Uttar Permanent Address: KHAS,Dist:Allahabad,Uttar
Pradesh,212104 Pradesh,212104
Civil Lines, Allahabad, UP (ESIS
Dispensary / IMP for IP: Sivandih Bokaro, JH (ESIS Disp.) Dispensary / IMP for Family: Disp.)
UHID: NA ABHA Number: NA
UAN: NA EmailID: NA
ABHA Address: NA Aadhaar: NA
Employer's Code No.: 21000604500000999 Employer's Code No.: None
Sub Unit's Code No.: None Sub Unit's Code No.: None
Date of Appointment: 22/08/2024 First Insurance No.: None
TRIVENI CONSTRUCTION AND
Name of Employer: REFRACTORIES
Name of Employer: None
87 Chak Imam
Address of Employer: Ali,Naini,Naini,Dist:AllahabadUttar Address of Employer: None
Pradesh211008

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
--- --- --- --- --- --- --- ---
Nominee Details
Percentage
Name of Nominee Relationship with IP Date of Birth UHID/ABHA Number Address of Nominee
Allotted
MAHUARI
KHURD,MANDA
RAM KRISHNA Dependant mother NA NA 100
KHAS,Uttar
PradeshDist:Allahabad
Documents none
Uploaded:

BO - Allahabad,40F/18, Ist Floor, P.D.Tondon Road, Civil Lines,Allahabad-211001,0


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

Mobile No. :
8569485556

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.

Download/Print Close

https://www.esic.in/ESICInsurance1/Employee/CounterFoilPage.aspx?empeRegPk=ngBGOLBLb4qoyKOyrXl2kg==&emprMasterPk=TZguD27ED… 1/1

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