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User Thursday, March 07, 2019

59421523250020999
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EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

Insured Person : VENU GOPAL

Insurance No. : 5900029866
Date of Registration : 11/03/2011
In case Aadhaar Number is not entered , this is valid up to 09/04/2011
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 Type of
VENU GOPAL None
Name: Disability:
Name of
Father / S.RAMA RAO Date of Birth: 02/10/1988
Husband:
Marital
Married Gender: Male
Status:
ACHARYA VINAOBHA NAGAR DEVBALODA ACHARYA VINAOBHA NAGAR DEVBALODA
Present Permanent
P.O-BMY P.O-BMY
Address: CHARODA,P.S-BHILAI-3,Dist:Durg,Chhattishgarh
Address: CHARODA,P.S-BHILAI-3,Dist:Durg,Chhattishgarh
Aadhaar Aadhaar
288281987946 Unverified
Number: Status:
Dispensary / Dispensary /
North Vasundara Nagar, Bhilai, Durg, CT (ESIS North Vasundara Nagar, Bhilai, Durg, CT (ESIS
IMP / mEUD IMP / mEUD
Disp.) Disp.)
for IP: for Family:
Employer's Employer's
42001523250000999 59000008450001001
Code No.: Code No.:
Sub Unit's Sub Unit's
59421523250020999 None
Code No.: Code No.:
First
Date of
01/11/2017 Insurance None
Appointment:
No.:
Name of Name of
KRISHNA ENGINEERING WORKS Shashi Engg. Company
Employer: Employer:
Address of QTR NO-B/7,PRAGATI NAGAR,PO- Address of c/o Shri Ajay Kumar Tiwari LIG 47 Hirapur
Employer: JAMNIPALI,KORBA,Dist:KorbaChhattishgarh495450 Employer: Rai,Default Address2,NoneDist:373Chhattishgarh

Family Details

Relationship with Place of Aadhaar

Name Date of Birth Whether Residing with IP Aadhaar
the Employee Residence Status
State District
S.RAMA
Dependant father 14/09/1956 Yes Chhattishgarh Durg NA NA
ROA
S.NAGMANI Dependant mother 12/08/1963 Yes Chhattishgarh Durg NA NA
Nominee Details
Percentage Aadhaar
Name of Nominee Relationship with IP Address of Nominee Aadhaar
Allotted Status
ACHARYA VINAOBHA NAGAR DEVBALODA
S.RAMA RAO Dependant father 100 P.O-BMY NA NA
CHARODA,P.S-BHILAI-3,ChhattishgarhDist:Durg
Documents Uploaded: none

BO - Korba,Near SBI, BALCO Township, Korba,0

Signature / LTI of Registered

Employee / IP :

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Affix Your Family Photograph Here.(Attested and Stamped

by Employer / ESIC Official)

Mobile No. :

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. Employer to please affix employee and his family photo here and attest with official stamp across.
*If Aadhaar number is present, this e-Pehchan Card is valid till IP is eligible for treatment.

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