EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

Insured Person : Raj Kumar Khdiya

In case Aadhaar Number is not entered,this is valid upto
Insurance No. : 5916810288
date: 17/08/2018 only
Date of Registration : 19/07/2018

YOUR REGISTRATION DETAILS

Employee Name: Raj Kumar Khdiya Type of Disability : None

Name of Father / Husband: REAMKISHAN KHDIYA Date of Birth : 05/08/1998

Marital Status : Unmarried Gender : Male

AT- KASHICHUA, PO.- DOOMAR PALI,

Present Address : Permanent Address :
DONGITARAI,Dist:Raigarh,Chhattishgarh,496 RIKOKALA,Dist:Raigarh,Chhattishgarh,4
661 92112

Aadhaar Number : 974148427875 Aadhaar Status : Unverified

Dispensary / IMP for IP : Patrapali, CT (ESIS Disp.) Dispensary / IMP for Family: Patrapali, CT (ESIS Disp.)

Current Employer Details First Employer Details

Employer's Code No. : 59001522720001099 Employer's Code No. : None

Sub Unit's Code No. : None Sub Unit's Code No. : None
Date of Appointment : 19/07/2018 First Insurance No. : None

Name of Employer : HARIKRISHAN PATEL Name of Employer : None

AT-GEJAMUDA,K.M.
Address of Employer : Address of Employer : None
NAGAR,RAIGARH,JSPL,RAIGARH,Dist:Rai
garhChhattishgarh496001

Family Details:
Relationship Whether
Name Date of Birth State District Aadhaar Aadhaar Status
with the Residing with
Employee Insured Person
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Nominee Details:
Name of Nominee Relationship with IP Percentage Address of Nominee Aadhaar Aadhaar Status
LOCHNI BAI Dependant mother AT.- KASHICHUWA,,PO.-
100 NA NA
KONDTARAI,ChhattishgarhDist:R
aigarh496661
Documents Uploaded:
none

Signature / LTI of Registered Employee / IP :

Affix Your Family Photograph Here.(Attested and Stamped by Employer / ESIC Official)

Mobile Number :

NOTE:
1. Please keep this printout for future reference and bring this along with your Photo ID for all your Claim Benefits and Medical Benefits.
2. Employer to please affix employee and his family photo here and attest with official stamp across .

Signature / Stamp of ESIC Officer / Employer

 Employees’ State Insurance Corporation is a premier organization providing Social Security to workforce in the form of Medical and
Cash Benefits in the contingencies of Sickness, Maternity, Disablement or death due to employment injury.

SI.No Benefits Entitlement Duration Rate of Benefit

From day one of entering into Reasonable medical care, Super
1 Medical Benefit One should be an insured person
insurable employment to till date in Speciality treatment, comprehensive
insurable employment and during medical care & clinical investigation
the corresponding benefit period. as per eligibility
2(a) Sickness Benefit 78 days in relevant Contribution Up to 91 days in two 70% of average Daily wages
Period consecutive Benefit Period
2(b) Enhanced 78 days in one Contribution Period 7 days/ 14 days for male/female
100% of average Daily wages
Sickness Benefit insured person respectively for
undergoing sterilization operation
3 Extended 156 days in 4 consecutive 124 to 309 days may be 80% of average Daily wages
Sickness Benefit Contribution Period extended to 730 days in case of
specified long term diseases
Temporary From day one of entering As long as temporary 90% of average Daily wages
4(a)
Disablement Insurable employment disablement lasts
Benefit
Permanent From day one of entering For whole life Depending upon loss of
4(b) Disablement Insurable employment earning capacity of Insured
Benefit
5 Dependents From day one of entering 90% of average Daily wages.
Paid to the dependents of the
Benefit Insurable employment Shareable in fixed proportion.
Insured Person. Who dies as a
result of employment injury, in
manner as detailed in Rule 58
6 Maternity Benefit 70 days in immediately 26 weeks in case of normal 100% of average Daily wages
preceding 1 or 2 consecutive delivery for 1st two surviving child
Contribution Periods thereafter 12 weeks. 6 weeks in
case of miscarriage. 12 weeks
for commissioning/adopting
mother.

I. Unemployment allowance
Rajiv Gandhi Insurable employment for the last 2 For a maximum period of 24
at the rates of
7 Shramik Kalyana years with 78 days contribution paid/ months. Vocational training of up
Yojana payable in each Contribution Period, to 1 year for upgrading skill of i. 50% of last avg. daily
Involuntary Unemployment due to Insured Persons receiving wages - 0 to 12 Months.
closure of factory, retrenchment or unemployment allowance. ii. 25% of last avg. daily
permanent disablement due to wages - 13 to 24 Months
non-employment injury>40% 2. Medical care for self and
family during receipt of
unemployment allowance.
8 Funeral Expenses From day one of entering For defraying expenses on Actual expenses subject to a
Insurable employment funeral of an Insured Person maximum of Rs. 10000/-
Rs. 5000/- per case of confinement
Confinement No condition other than Up to two confinements
9 to an Insured Women or an Insured
expenses insurable employment.
person in respect of his wife in case
facilities for confinement are not
available in ESI institutions.
Superannuated/permanently
Medical facility within ESIC
Medical Care to retired/retired under VRS /Pre-mature
10 On yearly basis. on payment of Rs. 120/- for
retired Insured retirement/ permanently retired due to
self
Persons employment injury after being in
insurable employment for 5
years/spouses of such deceased
Insured Persons/spouses receiving
Dependent Benefit.

• For detailed information on benefits you are requested to visit website www.esic.nic.in or call toll free number 1800112526