ESI Corporation, Chennai

ESI Scheme

Coverage

Regional Office Chennai

Contact Information

Forms for employer

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.