ESIC Forms Directory
Downloadable resources and claim forms for the Employees' State Insurance Corporation
ESI Handbook (Tamil)
306K
A comprehensive guide explaining ESI rules, employee benefits, and claim procedures, localized in the Tamil language.
Download PDF
Form 01 - Employers Registration
110K
Used by employers to initially register their factory or establishment under the ESI Act within 15 days of the Act becoming applicable to them.
Download Form 01
Form 01 A - Annual Info on Factory
77K
An annual declaration submitted by the employer detailing vital information about the factory/establishment to keep ESIC records updated.
Download Form 01 A
Form 1 - Declaration Form
118K
Used to register a new employee under the ESI scheme. It includes the employee's personal and family details to issue the Pehchan (Identity) card.
Download Form 1
Form 2 - Family Declaration Update
79K
Used by the insured person to add or delete family members (like a newborn child or deceased dependent) from their initial ESI declaration.
Download Form 2
Form 3 - Return of Declarations
62K
A covering letter/return form submitted by the employer to the ESI branch office when forwarding the Form 1 declarations of their employees.
Download Form 3
Form 5 A - Advance Payment Statement
77K
A statement provided by employers who have opted to make advance payments of their ESI contributions.
Download Form 5 A
Form 5 - Return of Contributions
44K
A half-yearly return filed by the employer containing details of employee wages and the ESI contributions paid during the contribution period.
Download Form 5
Form 6 - Register of Employees
62K
A mandatory register maintained by the employer recording the attendance, wages, and ESI contribution details for every covered employee.
Download Form 6
Form 9 - Claim for Sickness/TDB
86K
Used by an insured person to claim cash benefits for periods of sickness, Temporary Disablement Benefit (TDB), or sickness arising out of maternity.
Download Form 9
Form 10 - Employer Reply
56K
A form used by the employer to furnish required replies or clarifications to the ESIC office, usually regarding a workplace accident or an employee's claim.
Download Form 10
Form 11 - Accident Book
57K
A statutory register kept at the factory/workplace to record the details of any accident causing injury to an employee.
Download Form 11
Form 14 - Claim for PDB
56K
Used by an employee to claim Permanent Disablement Benefit (PDB) if an employment injury results in a permanent loss of earning capacity.
Download Form 14
Form 15 - Claim for Dependant Benefit
75K
Submitted by the surviving dependents of a deceased insured person to claim compensation if the death was caused by an employment injury.
Download Form 15
Form 16 - Periodical Payments Claim
60K
Used by dependents who are entitled to ongoing, periodical pension payments to officially claim their periodic installments.
Download Form 16
Form 19 - Maternity Benefit Claim
60K
Filled out by an insured woman to claim Maternity Benefit (paid leave) and to give notice of expected work absence due to pregnancy.
Download Form 19
Form 20 - Maternity Benefit (After Death)
72K
Used by a nominee or legal representative to claim pending maternity benefits if the insured woman dies during her maternity leave period.
Download Form 20
Form 22 - Funeral Expenses Claim
73K
Used by the eldest surviving member of the family (or the person who incurred the expenditure) to claim a lump-sum amount for the funeral of a deceased insured person.
Download Form 22
Form 23 - Life Certificate for PDB
60K
A certificate declaring that the beneficiary is still alive, required to ensure the uninterrupted continuation of Permanent Disablement Benefits.
Download Form 23
Form 24 - Dependant Benefit Certificate
73K
A periodic declaration submitted by dependents (like a widow confirming she hasn't remarried) to continue receiving dependent benefits.
Download Form 24
Form 37 - Certificate of Re-employment
154K
A certificate declaring an individual's re-employment status, which may affect their ongoing eligibility for specific ESI compensation benefits.
Download Form 37
Form 86 - Certificate of Employment
19K
An emergency certificate issued by the employer confirming a worker is employed with them, used when the employee needs urgent medical care but doesn't have an ESI card yet.
Download Form 86
Form 105 - Certificate of Entitlement
19K
A certificate allowing an insured person or their family members to avail ESI medical facilities outside their designated home state or station (e.g., while traveling).
Download Form 105
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