ESIC Services
Medical Helpline 1800-11-3839 for emergency and seeking guidance.

Downloads

FORM NO. SUBJECT RELEVANT REGULATION TO BE USED BY
FORM-01 Employer's Registration Form size:(14.1 KB) 10 B Employer
FORM-01(A) Form of annual information on factory/establishment covered under ESI Act size:(35.7 KB) 10 C Employer
FORM-1 Declaration Form size:(42.9 KB) 11 & 12 Employer
FORM-1(A) Family Declaration Form size:(32.0 KB) 15-A Employer
FORM-2 Addition/Deletion in Family Declaration Form size:(70.5 KB) 15-B Employer
FORM-3 Return of Declaration Form size:(32.9 KB) 14 Employer
FORM-5 Return of Contribution size:(39.6 KB) 26 Employer
FORM-5(A) Advance payment of contribution size:(33.5 KB) 31 Employer
FORM-5 (New) Return of Contribution (New) 31 Employer
FORM-6 Register of Employees size:(41.0 KB) 32 Employer
FORM-9 Claim for Sickness/ Temporary Disablement Benefit/Maternity Benefit size:(41.3 KB) 63 & 89(B) IP/Beneficiary
FORM-11 Accident Book size:(34.5 KB) 66 Employer
FORM-12 Accident Report from Employer size:(42.1 KB) 68 Employer
FORM-14 Claim for Permanent Disablement Benefit size:(24.6 KB) 76(A) IP/Beneficiary
FORM-15 Claim for Dependent Benefit size:(100 KB) 80 IP/Beneficiary
FORM-16 Claim for periodical payment of Dependent Benefits size:(40.8 KB) 83(A) IP/Beneficiary
FORM-19 Claim for Maternity Benefit and notice of work size:(38.8 KB) 88, 89 & 91 IP/Beneficiary
FORM-20 Claim for Maternity Benefit after the death of an Insured Women leaving behind the child size:(32.3 KB) 89(A) IP/Beneficiary
FORM-22 Funeral Expenses Claim size:(32.8 KB) 95(E) Beneficiary
FORM-23 Life Certificate for Permanent Disablement Benefit size:(40.6 KB) 107 IP/Beneficiary
FORM-24 Declaration and Certificate for Dependents Benefit size:(44.2 KB) 107(A) IP/Beneficiary
 
FORM NO. SUBJECT TO BE USED BY
ESIC-32 Wage/Contributory record for disablement benefit size:(44.6 KB) Employer
ESIC-37 Certificate of re-employment/continuous employment size:(20.2 KB) Employer
ESIC-53 Application for change in particulars of Insured Persons regarding change of Branch Office/Dispensary size:(15.1 KB) IP/Beneficiary
ESIC-63 Declaration form regarding payment to the legal heir/representative of the deceased IP size:(22.0 KB) IP/Beneficiary
ESIC-71 Particulars of contribution in case Return of Contribution in respect of an IP not sent size:(35.9 KB) Employer
ESIC-72 Application for duplicate Identity Card size:(32.7 KB) IP/Beneficiary
ESIC-86 Certificate of Employment size:(18.5 KB) Employer
ESIC-105 Certificate of Entitlement size:(19.4 KB) Employer
ESIC-126 Certificate of continuous employment for Extended Medical and Sickness Benefit Employer
ESIC-142 Claim for conveyance allowance and/or compensation for loss of wages for an IP appeared before the medical board size:(39.0 KB) IP/Beneficiary
C-1,2 & 6 Proforma for Survey Register size:(55.6 KB)  
C-18, Actual, Interest, C-19, 20, 22 & 23, D-18 & D-19 Proformas size:(231 KB)  
C-2 to C-5 & C-7 to C-12 Proformas size:(162 KB)