EMPLOYEES' STATE INSURANCE CORPORATION

e-Pehchan Card

Insured Person :

YOUR REGISTRATION DETAILS

Employee Name: Type of Disability :

Name of Father / Husband: Date of Birth :

Gender :

Present Address : Permanent Address :

Current Employer Details

Employer's Code No. : Employer's Code No. :

Date of Appointment : First Insurance No. :

Name of Employer :

Address of Employer :

Name of Employer :

Address of Employer :

TARA CHAND

Female

10001211110000699

First Employer Details

None

NAIR INNOVATIONS PRIVATE LIMITED

C-7 PREET VIHAR DELHI,Dist:New

DelhiDelhi110092

Insurance No. :

Date of Registration :

101*******

14/12/2017

Sub Unit's Code No. : None Sub Unit's Code No. :

Rajshree

Rajshree None

04/08/1997

15/104 KALYANPURI,Dist:East Delhi,Delhi

None

Dispensary / IMP for IP : Mayur Vihar, DL (ESIC Disp.) Marital Status : Unmarried

15/104 KALYANPURI,Dist:East Delhi,Delhi

15/11/2017

None

None

None

Aadhaar Number : 524********* Aadhaar Status : Verified In case Aadhaar Number is not entered,this is valid upto date: 12/01/2018 only

Dispensary / IMP for Family: Mayur Vihar, DL (ESIC Disp.) Family Details:

State District

Whether

Residing with

Insured Person

Date of Birth

Relationship

with the

Employee

Name Aadhaar Aadhaar Status

Delhi East Delhi

15/08/1972

murti devi Dependant mother

Yes 321********* Unverified

Delhi East Delhi

10/08/1971

tara chand Dependant father

Yes 317********* Unverified

Nominee Details:

KALYAN PURI,DelhiDist:New

Delhi

Address of Nominee

100

Name of Nominee Relationship with IP Percentage

TARA CHAND Dependant father

Aadhaar Aadhaar Status

NA NA

none

Documents Uploaded:

Signature / LTI of Registered Employee / IP :

Affix Your Family Photograph Here.(Attested and Stamped by Employer / ESIC Official) Mobile Number :

NOTE:

Signature / Stamp of ESIC Officer / Employer

1. Please keep this printout for future reference and bring this along with your Photo ID 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 . Employees’ State Insurance Corporation is a premier organization providing Social Security to workforce in the form of Medical and Cash Benefits in the contingencies of Sickness, Maternity, Disablement or death due to employment injury. SI.No Benefits Entitlement Duration Rate of Benefit 1 Medical Benefit One should be an insured person

From day one of entering into

insurable employment to till date in

insurable employment and during

the corresponding benefit period.

Reasonable medical care, Super

Speciality treatment, comprehensive

medical care & clinical investigation

as per eligibility

Up to 91 days in two 70% of average Daily wages

consecutive Benefit Period

78 days in relevant Contribution

Period

2(a) Sickness Benefit

100% of average Daily wages

7 days/ 14 days for male/female

insured person respectively for

undergoing sterilization operation

Enhanced 78 days in one Contribution Period

Sickness Benefit

2(b)

124 to 309 days may be 80% of average Daily wages

extended to 730 days in case of

specified long term diseases

156 days in 4 consecutive

Contribution Period

Extended

Sickness Benefit

3

As long as temporary 90% of average Daily wages

disablement lasts

From day one of entering

Insurable employment

Temporary

Disablement

Benefit

4(a)

Depending upon loss of

earning capacity of Insured

From day one of entering For whole life

Insurable employment

Permanent

Disablement

Benefit

4(b)

90% of average Daily wages.

Paid to the dependents of the Shareable in fixed proportion. Insured Person. Who dies as a

result of employment injury, in

manner as detailed in Rule 58

From day one of entering

Insurable employment

Dependents

Benefit

5

26 weeks in case of normal 100% of average Daily wages delivery for 1st two surviving child

thereafter 12 weeks. 6 weeks in

case of miscarriage. 12 weeks

for commissioning/adopting

mother.

70 days in immediately

preceding 1 or 2 consecutive

Contribution Periods

6 Maternity Benefit

I. Unemployment allowance

at the rates of

i. 50% of last avg. daily

wages - 0 to 12 Months.

ii. 25% of last avg. daily

wages - 13 to 24 Months

2. Medical care for self and

family during receipt of

unemployment allowance.

For a maximum period of 24

months. Vocational training of up

to 1 year for upgrading skill of

Insured Persons receiving

unemployment allowance.

Insurable employment for the last 2

years with 78 days contribution paid/

payable in each Contribution Period,

Involuntary Unemployment due to

closure of factory, retrenchment or

permanent disablement due to

non-employment injury>40%

Rajiv Gandhi

Shramik Kalyana

Yojana

7

Actual expenses subject to a

maximum of Rs. 10000/-

From day one of entering

Insurable employment

8 Funeral Expenses For defraying expenses on

funeral of an Insured Person

Rs. 5000/- per case of confinement

to an Insured Women or an Insured

person in respect of his wife in case

facilities for confinement are not

available in ESI institutions.

No condition other than Up to two confinements

insurable employment.

Confinement

9 expenses

Medical facility within ESIC

on payment of Rs. 120/- for

self

On yearly basis.

Superannuated/permanently

retired/retired under VRS /Pre-mature

retirement/ permanently retired due to

employment injury after being in

insurable employment for 5

years/spouses of such deceased

Insured Persons/spouses receiving

Dependent Benefit.

10

• For detailed information on benefits you are requested to visit website www.esic.nic.in or call toll free number 180******* Medical Care to

retired Insured

Persons

Contact this candidate