EMPLOYEES' STATE INSURANCE CORPORATION
e-Pehchan Card
PERSONAL DETAILS
Name of IP : JAMAAL BASHA A Insurance No. : 6383021555
Date of Birth : 13/04/1996 UHID : TN01.0018067469
Gender : Male UAN : 101570784970
Mobile Number : 9042943902 ABHA Number : 11-7820-0154-7462
Email ID : jamaalbashaa@gmail.com ABHA Address : jamaal@abdm
Registration Date : 19/01/2024 Aadhaar : Verified
REGISTRATION DETAILS
Marital Status : Unmarried Name of Father / : Ahmed Basha
Husband
Type Of Disability : NA
Present Address : Dharmapuri,Dist:Dharmapuri,Tamilnadu Permanent Address : Dharmapuri,Dist:Dharmapuri,Ta
milnadu
Dispensary / : Dharmapuri, TN (ESIS Disp.) Dispensary / : Dharmapuri, TN (ESIS Disp.)
IMP for IP IMP for Family
CURRENT EMPLOYER DETAILS
Employer's Code : 50000189580001099 Name of Employer : TeamLease Services Ltd
No.
Sub Unit's Code : 51500189580051099 Date of : 08/07/2025
No. Appointment
Address of : 315 Work Avenue Campus, Ascent Branch Office : BO - Adayar (Kanchipuram),No.
Employer Building 77,Jyoti Nivas College Rd, 112 Thiruvalluvar Salai, Shree
Koramangala Industrial Venkateswara Complex,
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
same as
Ahmed Basha Dependant father NA NA above,TamilnaduDist:Dharma 100
puri
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) : TeamLease Services Ltd
IP Number : 6383021555
Address : Dharmapuri,Dist:Dharmapuri,Tamilnadu
Date : 08/07/2025 10:50:33
Page 2 of 2
