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Today i am providing a useful information on various ESI Forms covered under ESI Act 1948 and their uses and some relevant information. Have a look...
That is all for today. OPEN UP and Good Night... :)
Today i am providing a useful information on various ESI Forms covered under ESI Act 1948 and their uses and some relevant information. Have a look...
Form-01 Employers
Registration Form
To be submitted to Sub Regional
Office promptly or within maximum 15 days of applicability of ESI Act for
registration and getting ESI Code No.(s).
Form-1 Declaration
Form (DF) in respect of coverable employees
To be submitted to Appropriate
Branch Office within 10 days from the date of insurable employment along with return of
Declaration Form
Form-1B Subsequent change(s) in the
family particulars to be furnished to the Branch Office concerned.
Form-3 Return
of Declaration Form
Form-6 Return of Contributions (RC)
based on Form-7 Register with insurance number in the ascending order to be
submitted in quadruplicate for half-yearly periods
i.e. April to September &
October to March to Appropriate Branch Office within 42 days from expiry of
periods i.e. by 11th November/ 12th May.
Form-6A Return relating to advance payment
of contribution in the same manner as in case of Form-6.
Form-7 Register of employees under
Regulation-32. The wage particulars of
all the coverable employees along with insurance numbers have to be recorded
contribution period wise. The Register
is to be collected by the employer from market.
Form-12 Form for claiming cash benefits
relating to SB/ESB/TDB/MB etc. from Branch Offices.
Form-16 Accident Report in case of
employment injury to be prepared in triplicate. The original copy is to be
furnished to the concerned Branch Office within 48 hours in ordinary case and
immediately in respect of death cases. One copy is to be sent to Chief
Inspector of Factories and another to the Insurance Medical Officer concerned.
Form-18A Form
for claiming periodical Dependant’s Benefit.
Forms-18A &27 Declaration
Certificate for claiming Dependant’s Benefit.
Form-24 Maternity Benefit - Notice of work
Form-24A Form to claim Maternity Benefit after
death of an Insured Person leaving behind the child.
Form-24B Maternity
Benefit Death Certificate.
Form-25 Form
for claiming PDB from Branch Office.
Form-25A Form for claiming Funeral Expenses
under Regulation 95E to be submitted alongwith Death Certificate/ Declarations
duly attested within 3 months from the date of death.
Form-26 Live certificate as required under
Regulation 107 for claiming PDB at half-yearly interval i.e. January/July.
Form-28 Abstention verification
certificate. Employer has to confirm
abstention position in respect of a particular insured person/woman as per
request of Branch Office Manager for speedy settlement of claims.
ESIC-32 Particulars of wage paid/payable
to ascertain the benefit rates of TDB where the employment injury happened
before completion of first Wage Period/Contribution Period.
ESIC-37 Certificate of re-employment
/continuing employment to be furnished in case of exit cases.
ESIC-53 Application for changes in
dispensary/residential address to be furnished to concerned Branch Office.
ESIC-71 In absence of RC/CCP,
wage/contribution particulars to settle claims of employees to be furnished by
employer on demand.
ESIC-72-A Application
for Duplicate Identity Card /Replacement of Defaced Identity Card duly authenticated by IMP/employer.
ESIC-86 Certificate
of employment to authorize medical benefit to newly appointed employees prior to receipt of IC or
Temporary Identity Certificate.
ESIC-105 Certificate
of employment to authorize medical treatment at temporary resident on leave/ tour etc. valid for 3 months.
That is all for today. OPEN UP and Good Night... :)
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