EMPLOYEES' STATE INSURANCE CORPORATION
e-Pehchan Card
PERSONAL DETAILS
Name of IP : SARANIYA KISHORBHAI PRAKASHBHAI Insurance No. : 3813152773
Date of Birth : 02/03/2004 UHID : GJ01.0006753533
Gender : Male UAN : NA
Mobile Number : 9537576349 ABHA Number : NA
Email ID : NA ABHA Address : NA
Registration Date : 19/06/2024 Aadhaar : NA
REGISTRATION DETAILS
Marital Status : Unmarried Name of Father / : PRAKASHBHAI
Husband
Type Of Disability : NA
Present Address : SALIYA,,SALIYA,,Dist:Panchmahal,Gujara Permanent Address : SALIYA,,SALIYA,,Dist:Panchm
t,389120 ahal,Gujarat,389120
Dispensary / : D 1 Halol Baroda, GJ (ESIS Disp.) Dispensary / : D 1 Halol Baroda, GJ (ESIS
IMP for IP IMP for Family Disp.)
CURRENT EMPLOYER DETAILS
Employer's Code : 38000542030001099 Name of Employer : VALIDATE PAYROLL LLP
No.
Sub Unit's Code : None Date of : 12/06/2024
No. Appointment
Address of : 2ND 208 IVORY TERRACE,,OPPOSITE Branch Office : BO- GorwaGrade -I,D-2,
Employer CIRCUIT HOUSE,,R C DUTT ROAD, Dispensary Building, Near
Vegitable Market, Alembic
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
SALIYA,,SALIYA,,GujaratDis
PRAKASHBHAI Dependant father NA NA t:Panchmahal389120 100
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) : VALIDATE PAYROLL LLP
IP Number : 3813152773
Address : SALIYA,,SALIYA,,Dist:Panchmahal,Gujarat,389120
Date : 19/06/2024 7:28:31PM
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