| FORM NO. |
SUBJECT |
RELEVANT REGULATION |
TO BE USED BY |
| FORM-01 |
Employer's Registration Form |
10 B |
Employer |
| FORM-01(A) |
Form of annual information on
factory/establishment covered under ESI Act |
10 C |
Employer |
| FORM-1 |
Declaration Form |
11 & 12 |
Employer |
| FORM-1(A) |
Family Declaration
Form |
15-A |
Employer |
| FORM-2 |
Addition/Deletion in Family Declaration
Form |
15-B |
Employer |
| FORM-3 |
Return of Declaration Form |
14 |
Employer |
| FORM-5 |
Return of Contribution |
26 |
Employer |
| FORM-5(A) |
Advance payment of contribution |
31 |
Employer |
| FORM-5 (New) |
Return of Contribution (New) |
31 |
Employer |
| FORM-6 |
Register of Employees |
32 |
Employer |
| FORM-9 |
Claim for Sickness/ Temporary Disablement
Benefit/Maternity Benefit |
63 & 89(B) |
IP/Beneficiary |
| FORM-11 |
Accident Book |
66 |
Employer |
| FORM-12 |
Accident Report from
Employer |
68 |
Employer |
| FORM-14 |
Claim for Permanent Disablement Benefit |
76(a) |
IP/Beneficiary |
| FORM-15 |
Claim for Dependent Benefit |
80 |
IP/Beneficiary |
| FORM-16 |
Claim for periodical payment of Dependent
Benefits |
83(A) |
IP/Beneficiary |
| FORM-19 |
Claim for Maternity Benefit and notice of
work |
88, 89 & 91 |
IP/Beneficiary |
| FORM-20 |
Claim for Maternity Benefit after the
death of an Insured Women leaving behind the child |
89(A) |
IP/Beneficiary |
| FORM-22 |
Funeral Expenses Claim |
95(E) |
Beneficiary |
| FORM-23 |
Life Certificate for Permanent Disablement
Benefit |
107 |
IP/Beneficiary |
| FORM-24 |
Declaration and Certificate for Dependents
Benefit |
107(A) |
IP/Beneficiary |
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