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
- 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 email@example.com.
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.
Employer’s (Company / Firm Registration Form
Employee Declaration Form
Family member Declaration Form
Addition / Deletion in Family Declaration Form
Return of Declaration Form
Return of Declaration Form (Half Yearly)
Claim for Sickness / Temporary Disable-ment Benefit / Maternity Benefit
Accident Report from Employer
Claim form for Permanent Disable-ment Benefit
Claim form for Dependent Benefit
Claim form for Periodical Payment of DB
Claim form for Maternity Benefit and Notice of Work
Claim for Funeral Expenses
Declaration and Certificate for Dependent Benefit
Wage Or - Record For Diablement Benefit
Certificate of Re-employ-ment or continuing Employ-ment
Application for change in particulars of Insured Persons (IPs)
Declaration form regarding payment to the legal heir of IP
Particulars of contribution in case RC in respect of an IP
Certificate for Employ-ment
Form of Certificate of Depen-dency