ESIC Forms Download
Under the Employees State Insurance (ESI) scheme, IPs or dependent family members will need to fill out and submit relevant forms available on the ESIC portal for making claims.
Some of the forms include Form 23, Form 24, Form 72, Form 86, and so on.
The Employees' State Insurance Scheme (ESIC) is a health insurance scheme designed with the intent to protect the interests of workers in times of medical emergencies like
- maternity,
- sickness,
- permanent or temporary physical disablement,
- employment-related death,
- a temporary loss of one's physical abilities,
- an occupationally-related death,
- or an accident that results in a loss of income or the ability to earn.
It is a social security scheme that is self-financed, where employers contribute 4.75% and employees contribute 1.75% of their wages.
The ESI scheme is run by the Employees' State Insurance Corporation, which is a separate body under the Ministry of Labour and Employment.
It follows the rules of the ESI Act of 1948. Employees who have a monthly salary of Rs. 21,000 or less are eligible to enrol in the Employees' State Insurance Scheme.
This scheme provides the following benefits to registered employees and their dependent family members:
- Medical benefit
- Maternity benefit
- Sickness benefit
- Pension benefit
- Dependent benefit
- Disablement benefit
- Funeral and confinement expenses
How to Register for the ESI scheme?
The ESI plan needs any establishment or company that employs more than 10 employees to register for participation in the programme.
They are able to do so by entering the information that is needed through the ESIC portal, which can be accessed at www.esic.in.
In doing so, a code number comprising 17 digits is generated and sent to the email ID of the employer along with a registration form and the ESIC login credentials.
The employer can then log in using the credentials and fill in the mandatory information.
If the company runs into any problems while enrolling employees, they can send an email to the ESIC IT desk at the address itcare@esic.in.
Download ESIC Forms
For many conditions and critical situations registered employees or their dependent family members are required to fill out and submit various forms. These ESIC forms are available here to download for your convenience.
All ESIC Forms are listed below, download and use them as per your requirements.
No. | Form Purpose | Download |
Form 01 | Employer’s (Company / Firm Registration Form | |
Form 1 | Employee Declaration Form | |
Form 1A | Family member Declaration Form | |
Form 2 | Addition / Deletion in Family Declaration Form | |
Form 3 | Return of Declaration Form | |
Form 5 | Return of Declaration Form (Half Yearly) | |
Form 10 | Claim for Sickness / Temporary Disable-ment Benefit / Maternity Benefit | |
Form 11 | Accident Book | |
Form 12 | Accident Report from Employer | |
Form 14 | Claim form for Permanent Disable-ment Benefit | |
Form 15 | Claim form for Dependent Benefit | |
Form 16 | Claim form for Periodical Payment of DB | |
Form 19 | Claim form for Maternity Benefit and Notice of Work | |
Form 22 | Claim for Funeral Expenses | |
Form 24 | Declaration and Certificate for Dependent Benefit | |
ESIC 32 | Wage Or - Record For Diablement Benefit | |
ESIC 37 | Certificate of Re-employ-ment or continuing Employ-ment | |
ESIC 53 | Application for change in particulars of Insured Persons (IPs) | |
ESIC 63 | Declaration form regarding payment to the legal heir of IP | |
ESIC 71 | Particulars of contribution in case RC in respect of an IP | |
ESIC 86 | Certificate for Employ-ment | |
Dep-en-dency | Form of Certificate of Depen-dency |
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