ESI Scheme


Forms for employer:
Indoor Treatment Proforma for showing details of IPs Under Indoor Treatment
Sub-Code Allotment of Sub-Code Form
Form 01 Employers' Registration Form
Form - 01A Annual information of factory/estt submission form
Form 3 Return of Declaration forms
Form 5 Return of contributions
Form 5a Statement of advance payment of contributions
Form 6 Register of employees
Form 10 Abstention verification
Form 11 Accident Register
Forms for employees:
Form 1 Latest Declaration Form
Form 2 Addition / Deletion in Family declaration form
Form 9 Claim form for sickness /TDB/ Maternity
Form 14 Claim form for Permanent disablement benefit (PDB)
Form 15 Claim form for Dependant Benefit (DB)
Form 16 Claim form for periodical payments of DB
Form 19 Claim for Maternity benefit
Form 20 Claim form for Maternity benefit after death of child
Form 22 Claim form for Funeral Expenses
Form 23 Life certificate
Form 24 Dependant benefits declaration
Form 37 Certificate of Employment
Form 53 Claim form for Change of address
Changes in ESIC forms:
Changes will be effective from 1st January, 2005. The revised forms are available for download from this site.
Form 01 Regulation 10-B(a) Form-01 and Form 01-A
Form- 1 Regulation 11 & 12 Form-1
Form- 1-B Regulation 15-B Form-2
Form-6 Regulation 26 Form-5
Form-6 -A Regulation-31 (Second proviso) Form- 5-A
Form-7 Regulation 32(1)(a) Form-6
Form-8,9 & 10 Regulation 57, 58, 59, 89-B Form-7
Form-28 & 28-A Regulation 52-A(1) & (2) Form-10
Form-11 Regulation 61 & 89-B Form-8
Forms 12, 12-A, 13, 13-A, 14 & 14-A Regulation 63 & 89-B Form-9
Form-15 Regulation 66 Form-11
Form-16 Regulation 68 Form-12
Form-25 Regulation 76-A Form-14
Form-17 Regulation 79 & 95-C Form-13
Form-18 Regulation 80 Form-15
Form-18-A Regulation 83-A Form-16
Form 19 & 20 Regulation 87 Form-17
Form 21 & 23 Regulation 88(i)(iii) & 89 Form-18
Form-22 & 24 Regulation 88(ii), 89 & 91 Form-19
Form-24-A Regulation 89-A Form-20
Form-24-B Regulation 89-A Form-21
Form-25-A Regulation 95-E Form-22
Form-26 Regulation 107 Form-23
Form-27 Regulation 107-A Form-24

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Last Updated on February 23, 2007 22:10:11