EMPLOYEES' STATE INSURANCE CORPORATION
e-Pehchan Card
PERSONAL DETAILS
Name of IP : KAMMAKATLA VENKATESH Insurance No. : 4406702573
Date of Birth : 18/08/2002 UHID : NA
Gender : Male UAN : NA
Mobile Number : 8944098817 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 08/02/2024 Aadhaar : NA
REGISTRATION DETAILS
Marital Status : Unmarried Name of Father / : KAMMAKATLA
Husband
Type Of Disability : NA
Present Address : SHRAMIK VIHAR Permanent Address : 4-117A MAIN STREET
NISHA,Dist:Angul,Odisha,759111 JANDAPETA
PATHANOUPADA,Dist:Srikakul
am,Andhra Pradesh,532212
Dispensary / : Angul, OR (ESIS Disp.) Dispensary / : Angul, OR (ESIS Disp.)
IMP for IP IMP for Family
CURRENT EMPLOYER DETAILS
Employer's Code : 52000126070001099 Name of Employer : TATA PROJECTS LIMITED
No.
Sub Unit's Code : 44520126070021099 Date of : 09/02/2024
No. Appointment
Address of : Tata Projects Limited, C/o Jindal Steel Branch Office : BO - Angul,Branch Office, ESI
Employer and Power Limited,At- Nisha PO- Jindal Corporation, H/o Sri B. B.
Biswal,Bada Bazar (Bhagabati
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
4-117A MAIN STREET
KAMMAKATLA Dependant father NA NA JANDAPETA 100
PATHANOUPADA,Andhra
PradeshDist:Srikakulam5322
12
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- [Link]
Printed By (Employer/User Name) : TATA PROJECTS LIMITED
IP Number : 4406702573
Address : SHRAMIK VIHAR NISHA,Dist:Angul,Odisha,759111
Date : 09/02/2024 [Link]PM
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