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Surendra Esi

The document provides registration details for Surendra Singh, an insured person under the Employees' State Insurance Corporation, including personal information, family details, and employer information. Surendra Singh is registered with insurance number 6936304538, and his employer is Siddharth Automat (India) Pvt. Ltd. The document also includes instructions for retaining the printout for future reference and affixing photographs for identification purposes.

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sonuehs21
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15 views1 page

Surendra Esi

The document provides registration details for Surendra Singh, an insured person under the Employees' State Insurance Corporation, including personal information, family details, and employer information. Surendra Singh is registered with insurance number 6936304538, and his employer is Siddharth Automat (India) Pvt. Ltd. The document also includes instructions for retaining the printout for future reference and affixing photographs for identification purposes.

Uploaded by

sonuehs21
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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7/21/25, 12:06 PM CounterFoilPage

User Monday, July 21, 2025 12:06:03


69000377390000599
Login: PM

EMPLOYEES' STATE INSURANCE CORPORATION


e-Pehchan Card

Insured Person : SURENDRA SINGH


Insurance No. : 6936304538
Date of Registration : 08/07/2025
Medical Acceptance Card [Click Here to View Medical Acceptance Card]
YOUR REGISTRATION DETAILS
Please seed Universal Account Number (UAN)
Employee Name: SURENDRA SINGH Type of Disability: NA
Name of Father /
KISHAN SINGH Date of Birth: 26/12/2005
Husband:
Marital Status: Unmarried Gender: Male
Present Address: REWASI,SIKAR,Dist:Sikar,Rajasthan Permanent Address: REWASI,SIKAR,Dist:Sikar,Rajasthan
Dispensary / IMP for Neem Ka Thana, Sikar, RJ (ESIS
Dispensary / IMP for IP: Neem Ka Thana, Sikar, RJ (ESIS Disp.) Disp.)
Family:
UHID: RJ01.0006350339 ABHA Number: NA
UAN: NA EmailID: NA
ABHA Address: NA Aadhaar: NA
Employer's Code No.: 69000377390000599 Employer's Code No.: None
Sub Unit's Code No.: None Sub Unit's Code No.: None
Date of Appointment: 01/07/2025 First Insurance No.: None
Name of Employer: SIDHARTH AUTOMAT ( INDIA ) PVT.LTD. Name of Employer: None
P NO-137,SEC-
Address of Employer: 3,IMTMANESAR,Dist:GurgaonHaryana120050
Address of Employer: None

Family Details

Relationship Whether
UHID/ABHA ABHA Place of
Name with the Date of Birth UAN/Aadhaar Residing with
Number Address Residence
Employee IP
State District
KISHAN Dependant father 01/01/1973 RJ01.0006350340/NA
NA NA Yes Rajasthan Sikar
SINGH
KELU Dependant mother 01/01/1976 RJ01.0006350341/NA
NA NA Yes Rajasthan Sikar
KANWAR
Nominee Details
UHID/ABHA Percentage
Name of Nominee Relationship with IP Date of Birth Address of Nominee
Number Allotted
KISHAN SINGH Dependant father NA NA REWASI,SIKAR,RajasthanDist:Sikar 100
Documents none
Uploaded:

BO - Maneser ,ESI Corporation, ESIC HOSPITAL COMPLEX, GROUND FLOOR, PLOT NO. 41, SEC-03 IMT MANESAR-122050,
Affix Your Family Photograph Here.(Attested and Stamped by Employer /
Signature / ESIC Official)
LTI of
Registered
Employee /
IP :

Mobile No.
:
9610251630

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.

https://portal.esic.gov.in/ESICInsurance1//Employee/CounterFoilpage.aspx?empeRegPk=JAb4l0d3A6LCzKcjDEpXxg==&emprMasterPk=5PjhcT… 1/1

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