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    Jitendra Kumar Chouhan

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    vipulpatelkni2015

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Jitendra Kumar Chouhan

    Uploaded by

    vipulpatelkni2015
    3 views2 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views2 pages

    Jitendra Kumar Chouhan

    Uploaded by

    vipulpatelkni2015

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : JITENDRA KUMAR CHAUHAN Insurance No. : 4406580544


    Date of Birth : 01/01/1988 UHID : NA
    Gender : Male UAN : NA
    Mobile Number : 9691637291 ABHA Number : NA
    Email ID : NA ABHA Address : NA
    Registration Date : 16/11/2023 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Married Name of Father / : FAUJDAR CHAUHAN


    Husband
    Type Of Disability : NA
    Present Address : WARD NO 15,RAHAUD,JANJGIR Permanent Address : WARD NO
    CHAMPA,CHHATTISGARH,4955,Dist:Sun 15,RAHAUD,JANJGIR
    dargarh (Sundergarh),Odisha,495556 CHAMPA,CHHATTISGARH,495
    5,Dist:Sundargarh
    Dispensary / : FCI, OR (ESIS Disp.) Dispensary / FCI, OR (ESIS Disp.)
    : (Sundergarh),Odisha,495556
    IMP for IP IMP for Family

    CURRENT EMPLOYER DETAILS

    Employer's Code : 59000007190001001 Name of Employer : Rohini Transport Corporation


    No.

    Sub Unit's Code : 44590007190011001 Date of : 16/11/2023


    No. Appointment

    Address of : C/O-JITENDRA SETHI,AT-HATATOTA Branch Office : BO - Angul,Branch Office, ESI


    Employer ROAD,PO/PS-TALCHER,Dist:AngulOdis 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

    Page 1 of 2
    NOMINEE DETAILS

    UHID/
    Name of Nominee Relation with IP Date of Birth Address of Nominee Percentage(%)
    ABHA Number

    WARD NO
    FAUJDAR Dependant father NA NA 15,RAHAUD,JANJGIR 100
    CHAUHAN CHAMPA,CHHATTISGARH,4
    95556,OdishaDist:Sundargar
    h (Sundergarh)495556

    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) : Rohini Transport Corporation


    IP Number : 4406580544
    Address : WARD NO 15,RAHAUD,JANJGIR
    CHAMPA,CHHATTISGARH,4955,Dist:Sundargarh (Sundergarh),Odisha,495556
    Date : 16/11/2023 5:50:23PM

    Page 2 of 2

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