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Frequently asked questions- Special Declaration Form for Pehchan Cards

What is a Pehchan Card ?

 
Pehchan Card is a multi purpose plastic magnetic identification card to be issued to Insured Persons in place of existing conventional paper cards.  Two identical cards will be issued, one for the use of insured person and the other for the use of dependants / family members of the insured person.

What are its uses?

Pehchan Card can be used broadly -

a.    To avail medical treatment at any ESI Hospital / Dispensary across the country

b.    To claim and draw cash benefits at any ESI Branch Office across the country 

c.    To have an interface with any ESI institution

When will the Pehchan Card be issued?

Pehchan Card will be issued after necessary registration and capturing of biometric details of the insured persons and their eligible family members during Pehchan card camps, to be organized later at convenient locations in and around Coimbatore.

Why a fresh or special declaration form, and why not declaration form already submitted at the time of entry (old)?

Since data available in old declarations may be outdated / obsolete / stale, they will not be foolproof.  Submission of data in fresh declaration form is hence a must  to collect current data.  (This is in interest of the registering beneficiaries).

Where can I get the special declaration form for Pehchan card?
A specimen special declaration form for Pehchan card is being made available to each employer who can take sufficient number of copies.  It can also be downloaded from the website.

Should the special declaration form for Pehchan card to submitted, in specific size and content?

Yes, in A4 size.  No alteration in size or content is permitted.

 
How should the declaration form be filled in?

Declaration form in A4 size, has to be filled-in, in a legible manner, without any overwriting, so that, it can be read and processed easily.

Is it mandatory to fill all columns in the special declaration form for Pehchan card?
Yes. No columns should be left blank
Can I affix thumb impression in the special declaration form for Pehchan card?
Yes, in case of inability to sign
Can I affix employer seal in the declaration form in the address box?
You can affix the seal in a legible manner, without smudging
Should I affix photograph with the declaration form (Form 1) for Pehchan card?
No, photograph of IP / family need not be affixed now

(Photographing and capturing of bio-metric details of the insured person / family members will be done in the upcoming Pehchan card camps, to be organised later).

Should I continue to submit existing declaration forms in case of new entrants?
Yes.  In case of new entrants, existing declaration forms (Form 1) with Temporary Identification Certificate portion should be submitted with photograph, as usual.
Should I submit special declaration form for Pehchan card also in the case of such new entrants?
Yes.
Why such duplication in the case of a new entrant?
It is no duplication.  A new entrant requires a conventional paper card till he may get a Pehchan card.  Usual Form-a is necessary to get the present paper card initially. Special / fresh declaration form is necessary to get a Pehchan card subsequently.
Can I submit the data in electronic form?
Yes.  Please see specifications and sample database format
Whether the updated data in the special declaration form for Pehchan cards (e.g. dispensary option) can be adopted for practical purposes?
Yes, there must be no bar.  Please approach Branch Manager for necessary remedy.
Special declaration form for Pehchan card has been submitted.  What next?
Please watch out for announcement on Pehchan Card camps for photographing and biometrics
What will happen if the special declaration form for Pehchan card is not submitted or submitted with deficiencies?
Beneficiaries may face difficulties in getting Pehchan card later.  (hence submit, and submit without deficiency).
  How do an employer benefit from the above exercise?
An employer, being a major stake holder in ESI Scheme, may do well to offer his assistance in the current process, at the end of which his own data gets updated and pruned.
In case of difficulty / doubt, whom should I contact?
Please get in touch with the concerned Branch Manager / Area Insurance Inspector / Shri.M.Karthikeyan, Assistant Director, at Sub Regional Office (Mobile No.9843162890)                       or mail to     dir-kovai@esic.nic.in
 
 
 

 

Download Special Declaration Form

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Download Docket for declaration forms    
Guidelines

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