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Thursday, August 23, 2018

User Login: 38000235680001018
10:59:20 AM

EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

Insured Person : BHIMSINH

Insurance No. : 3810876537
Date of Registration : 05/04/2017
In case Aadhaar Number is not entered , this is valid up to 04/05/2017
For extending the validity, please get the Aadhaar number of self and family seeded through
Employer/staff of ESIC/IP portal or visit a Pehchan Camp along with family for giving Bio-
metrics/Photograph.
Medical Acceptance Card [Click Here to View Medical Acceptance Card]
YOUR REGISTRATION DETAILS
Employee Name: BHIMSINH Type of Disability: None
Name of Father /
DOLATSINH JADAV Date of Birth: 08/04/1971
Husband:
Marital Status: Married Gender: Male
VILL-BHUKHI,PO- VILL-BHUKHI,PO-
Present Address: Permanent Address:
ADADRA,Dist:Panchmahal,Gujarat,389341 ADADRA,Dist:Panchmahal,Gujarat,389341
Aadhaar Number: 579608927475 Aadhaar Status: Unverified
Dispensary / IMP for
Dispensary / IMP for IP: D 1 Halol Baroda, GJ (ESIS Disp.) None
Family:
Employer's Code No.: 38000235680001018 Employer's Code No.: None
Sub Unit's Code No.: None Sub Unit's Code No.: None
Date of Appointment: 23/08/2018 First Insurance No.: None
ESCORT SECURITY & PERSONAL
Name of Employer: Name of Employer: None
SERVICES
A-12, Vishwakarma Park,,Nr. Poonam
Address of Employer: Nagar,,Sama Road, Address of Employer: None
Vadodara,Dist:VadodaraGujarat390008

Family Details

Relationship with the Whether Residing with Place of Aadhaar

Name Date of Birth Aadhaar
Employee IP Residence Status
State District
--- --- --- --- --- --- --- ---
Nominee Details
Percentage Aadhaar
Name of Nominee Relationship with IP Address of Nominee Aadhaar
Allotted Status
VILL-BHUKHI,PO-
VIMLABEN Spouse 100 NA NA
ADADRA,GujaratDist:Panchmahal389341
Documents
none
Uploaded:

BO - Panigate,PANIGATE,0
Affix Your Family Photograph Here.(Attested and Stamped by
Employer / ESIC Official)
Signature / LTI of Registered
Employee / IP :

Mobile No. : 9662007926

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.

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