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    Esicard

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    Ajay Chauhan
    This document contains personal and employment details for Ajay Shashikant Chauhan who was registered for Employees' State Insurance on January 5, 2023. It lists his name, date of birth, insurance number, employer information, family details including his father Shashikant and mother Anita, and names his father as his nominee to receive 100% of benefits. The document was printed by his employer COGENT E-SERVICES LIMITED and contains his photograph and signature.

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

    Esicard

    Uploaded by

    Ajay Chauhan
    20 views2 pages
    This document contains personal and employment details for Ajay Shashikant Chauhan who was registered for Employees' State Insurance on January 5, 2023. It lists his name, date of birth, insurance number, employer information, family details including his father Shashikant and mother Anita, and names his father as his nominee to receive 100% of benefits. The document was printed by his employer COGENT E-SERVICES LIMITED and contains his photograph and signature.

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    esicard

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    This document contains personal and employment details for Ajay Shashikant Chauhan who was registered for Employees' State Insurance on January 5, 2023. It lists his name, date of birth, insurance number, employer information, family details including his father Shashikant and mother Anita, and names his father as his nominee to receive 100% of benefits. The document was printed by his employer COGENT E-SERVICES LIMITED and contains his photograph and signature.

    Copyright:

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

    Esicard

    Uploaded by

    Ajay Chauhan
    This document contains personal and employment details for Ajay Shashikant Chauhan who was registered for Employees' State Insurance on January 5, 2023. It lists his name, date of birth, insurance number, employer information, family details including his father Shashikant and mother Anita, and names his father as his nominee to receive 100% of benefits. The document was printed by his employer COGENT E-SERVICES LIMITED and contains his photograph and signature.

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    of 2

    EMPLOYEES' STATE INSURANCE CORPORATION

    e-Pehchan Card

    PERSONAL DETAILS

    Name of IP : AJAY SHASHIKANT CHAUHAN Insurance No. : 3416738229


    Date of Birth : 28/03/2001 UHID : NA
    Gender : Male UAN : NA
    Mobile Number : 6393397776 ABHA : NA
    Email ID : NA PHR Address : NA
    Registration Date : 05/01/2023 Aadhaar : NA

    REGISTRATION DETAILS

    Marital Status : Unmarried Name of Father / : Shashikant Chauhan


    Husband
    Type Of Disability : NA
    Present Address : Room No.2, Shripat Yadav Chawl, Permanent Address : Room No.2, Shripat Yadav
    Pokharan Road Chawl, Pokharan Road
    No.1,Dist:Thane,Maharashtra No.1,Dist:Thane,Maharashtra

    Dispensary / : Kalyan, MH (ESIS Disp.) Dispensary / : Kalyan, MH (ESIS Disp.)


    IMP for IP IMP for Family

    CURRENT EMPLOYER DETAILS

    Employer's Code : 67000374580001001 Name of Employer : COGENT E-SERVICES


    No. LIMITED

    Sub Unit's Code : 34670374580011001 Date of : 31/12/2022


    No. Appointment

    Address of : 4th & 5th FLOOR, LODHA I THINK Branch Office : BO - Thane,Panchdeep
    Employer TOWER,PALAVA, CITY Bhavan, Ground Floor, Plot No.
    A-12/1, MIDC, Next to Wagle

    FAMILY DETAILS

    Name Relation Date UHID/ABHA PHR UAN/ Is Residing State/District


    with of Birth Address Aadhaar with IP
    IP

    Maharashtra /
    Shashikant Dependant 25/05/1978 NA / NA NA NA Yes
    Chauhan father
    Thane

    Page 1 of 2
    Maharashtra /
    Anita Dependant 25/05/1978 NA / NA NA NA Yes
    mother
    Thane

    NOMINEE DETAILS

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

    same,MaharashtraDist:Thane
    Shashikant Chauhan Dependant father NA NA 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) : COGENT E-SERVICES LIMITED


    IP Number : 3416738229
    Address : Room No.2, Shripat Yadav Chawl, Pokharan Road No.1,Dist:Thane,Maharashtra

    Date : 05/01/2023 4:54:36PM

    Page 2 of 2

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