Download ESIC FORM 11 ACCIDENT BOOK EMPLOYEES' STATE INSURANCE CORPORATION As per Regulation 66

Declaration by a person taking up employment in an establishment in which the Employees’ Provident Funds & Family Pension Fund Scheme are in force.

Download ESIC FORM 11 ACCIDENT BOOK EMPLOYEES’ STATE INSURANCE CORPORATION

As per Regulation 66

66. Maintenance of accident book

Every employer shall—

(i) Keep a book readily accessible (hereinafter called ‘the Accident Book’) in [Form 11], in which the appropriate particulars of any accident causing personal injury to an insured person may be entered;

(ii)  Preserve every such book when it is completed for a period of five years from the date of the last entry thereon:

PROVIDED that it shall be necessary to enter in the said Accident Book particulars of any employment injury caused by an occupational disease specified in Schedule III to the Workmen’s Compensation Act, 1923:

PROVIDED FURTHER that an employer shall be deemed to have complied with this regulation sufficiently if in any register maintained by him, the appropriate particulars are also shown.

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Download ESIC C-2 to C-5 & C-7 to C-12: Supporting Documents with Form 1 for ESIC Registration

Download ESIC C-2 to C-5 & C-7 to C-12: Supporting Documents with Form 1 for ESIC Registration and Compliance with ESIC ACT,1948

As per ESIC Act ,1948 Section 2 A of the Employees’ State Insurance Act, 1948 Regulation 10 B of the E.S.I. Regulation 1950. SECTION 2-A.  Registration of factories and establishments — Every factory or establishment to which this Act applies shall be registered within such time and in such manner as may be specified in the regulations made in this behalf.

As per ESIC Act ,1948, Section 10B. Registration of factories or establishments

(a) The employer in respect of a factory or an establishment to which the Act applies for the first time and to  which an employer’s code number is not yet allotted and the employer in respect of a factory or an establishment to  which the Act previously applied but has ceased to apply for the time being, shall furnish to the appropriate regional  office not later than 15 days after the Act becomes applicable, as the case may be, to the factory or establishment, a
declaration or registration in writing in [Form No. 01 & Form No. 01 A] (hereinafter referred to as Employer’s Registration Form).

(b) The employer shall be responsible for the correctness of all the particulars and information required for and furnished on the employer’s registration form.

(c) The appropriate regional office may direct the employer who fails to comply with the requirements of paragraph (a) of this regulation within the time stated therein, to furnish to that office employer’s registration form duly completed within such further time as may be specified and such employer shall, thereupon, comply with the instructions, issued by that office in this behalf.

[(cc) The employer in respect of a factory or establishment to which a code number has been issued by the Corporation based on information collected or decision taken regarding applicability of the Act to such factory or establishment, shall, within fifteen days of receipt of information of allotment of code number, furnish a declaration in Form-01.

(d) Upon receipt of the completed employer’s registration form, the appropriate Regional Office shall, if satisfied  that the factory or the establishment is one to which the Act applies, allot to it an employer’s code number (unless the  factory or the establishment has already been allotted an Employer’s Code Number) and shall inform the employer of that number.

(e) The employer shall enter the employer’s code number on all documents prepared or completed by him in connection with the Act, the rules and these regulations and in all correspondence with the appropriate office.

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Download ESCI Form C-18, Actual, Interest, C-19, 20, 22 & 23, D-18 & D-19: Contribution to ESIC

Download ESCI Form C-18, Actual, Interest, C-19, 20, 22 & 23, D-18 & D-19: Contribution to ESIC. 

Section 39 and 40 of  THE EMPLOYEES’ STATE INSURANCE ACT, 1948. 

39.   Contributions. — (1) The contribution payable under this Act in respect of an employee shall comprise contribution payable by the em­ployer (hereinafter referred to as the employer’s contribution) and contri­bution payable by the employee (hereinafter referred to as the employee’s contribution) and shall be paid to the Corporation.

(2)   The contributions shall be paid at such rates as may be prescribed by the Central Government :

Provided that the rates so prescribed shall not be more than the rates which were in force immediately before the commencement of the Employees’ State Insurance (Amendment) Act, 1989 (29 of 1989).

(3)   The wage period in relation to an employee shall be the unit in respect of which all contributions shall be payable under this Act.

(4)   The contributions payable in respect of each wage period shall ordinarily fall due on the last day of the wage period, and where an employee is employed for part of the wage period, or is employed under two or more employers during the same wage period the contributions shall fall due on such days as may be specified in the regulations.

(5) (a)  If any contribution payable under this Act is not paid by the principal employer on the date on which such contribution has become due, he shall be liable to pay simple interest at the rate of twelve per cent. per annum or at such higher rate as may be specified in the regulations till the date of its actual payment :Provided that higher interest specified in the regulations shall not exceed the lending rate of interest charged by any scheduled bank.(b)   Any interest recoverable under clause (a) may be recover­ed as an arrear of land revenue or under section 45-C to section 45-I.

Explanation. — In this sub-section “ scheduled bank ” means a bank for the time being included in the Second Schedule to the Reserve Bank of India Act, 1934 (2 of 1934).]

40.  Principal employer to pay contributions in the first instance. — (1)  The principal employer shall pay in respect of every employee, whether directly employed by him or by or through an immediate employer, both the employer’s contribution and the employee’s contribution.

(2)   Notwithstanding anything contained in any other enactment but subject to the provisions of this Act and the regulations, if any, made thereunder, the principal employer shall, in the case of an employee directly employed by him (not being an exempted employee), be entitled to recover from the employee the employee’s contribution by reduction from his wages and not otherwise :

Provided that no such deduction shall be made from any wages other than such as relate to the period or part of the period in respect of which the contribution is payable] or in excess of the sum representing the employee’s contribution for the period.

(3)   Notwithstanding any contract to the contrary, neither the principal employer nor the immediate employer shall be entitled to deduct the employer’s contribution from any wages payable to an employee or otherwise to recover it from him.

(4)   Any sum deducted by the principal employer from wages under this Act shall be deemed to have been entrusted to him by the employee for the purpose of paying the contribution in respect of which it was deducted.

(5)   The principal employer shall bear the expenses of remitting the contributions to the Corporation.

I have to state that under Section 40, read with Section 39 of the Employees’ State Insurance Act, 1948 (hereinafter referred to as the Act), the Principal Employer of the factory/establishment covered under the Act, is required to pay, in respect of every employee, both the employer’s contribution and the employee’s contribution at the rates specified in Rule 51 of the E.S.I (Central) Rules, 1950 (as amended). The contributions are required to be paid in terms of Regulation 29,31 and 33 of the ESI (General) Regulations 1950 into a bank duly authorized by the Corporation, except where otherwise provided, and within the periods laid down for the purpose.

A return of contributions is to be submitted in Form-6 alongwith receipted copies of challans for the amount deposited in the Bank to the Branch Office of the Corporation at the expiry of each contribution period as specified under Regulation 26 of the Employees’ State Insurance (General) Regulations 1950.

It may also please be noted that in case of failure to pay contributions in accordance with Regulation 29, read with Regulations 31 of the ESI (General) Regulations 1950, interest @ 12% per annum becomes payable under Section 39(5) of the Act on arrears of contributions for each day of default or delay in payment of contributions. Any interest payable under Section 39 (5) of the act may be recovered under Section 45 C to 45 I of the Act.

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Download ESIC 142 FORM for Claim conveyance allowance and/or compensation for loss of wages for an IP appeared before the medical board

Download ESIC FORM ESIC – 142

 

Employees’ State Insurance Corporation As per ESIC Rule Medical authority under Regulation 71 (i) Directions by the Corporation —

Every claimant for and every beneficiary in receipt of disablement benefit shall comply with every direction given to him by the appropriate Regional Office which requires him either —

(i)To submit himself to a medical examination by such medical authority as may be appointed by that office for the purpose of determining the effect of the relevant employment injury or the treatment appropriate to the relevant injury or loss of faculty, or

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Download ESIC FORM ESIC – 72For : Application for duplicate Identity Card

Download ESIC FORM ESIC – 72

As per section 84 of the E.S.I. Act, 1948 SECTION84.      Punishment for false statement.—

Whoever, for the purpose of causing any increase in payment or benefit under this Act, or for the purpose of causing any payment or benefit to be made where no payment or benefit is authorised by or under this Act, or for the purpose of avoiding any payment to be made by himself under this Act or enab­ling any other person to avoid any such payment, knowingly makes or causes to be made any false statement or false representation, shall be punishable with imprisonment for a term which may extend to 1[six months] or with fine not exceeding 2[two thousand] rupees, or with both.[Provided that where an insured person is convicted under this section, he shall not be entitled for any cash benefit under this Act for such period as may be prescribed by the Central Government.]

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Download ESIC FORM ESIC-71 For Particulars of contribution in case Return of Contribution in respect of an IP not sent

Download ESIC FORM ESIC-71 Employees’ State Insurance Corporation As per ESIC Regulation 32 of the Employees’ State Insurance (General) Regulation, 1950

RULE32.     Register of Employees —

(1)  Every employer shall maintain a register in 4[Form 6] in respect of every employee of his factory or establishment.

(1) (a)  Register of employees engaged by immedi­ate employer. — Every immediate employer shall maintain a register in Form 6 in respect of every employee engaged by him and submit the same to the principal employer before the settlement of any amount payable under sub-section (1) of section 41 of the Act.

(2)     Every employer shall preserve every register maintained under this regulation after it is filled, for a period of five years from the date of last entry therein.

(3)     The employer shall give a reasonable opportunity to any of his employees, if he so desires to see entries in respect of such employee in this register once a month.

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Download ESIC FORM ESIC-63 For :Declaration form regarding payment to the legal heir/representative of the deceased IP

Declaration form regarding payment to the legal heir/representative of the deceased IP

Download ESIC FORM ESIC-63

Download ESIC FORM ESIC-63 Employees’ State Insurance Corporation DECLARATION FORM As per Section 71 of the ESI Act, 1948 SECTION71.         Benefit payable up to and including day of death. —[If a person dies] during any period for which he is entitled to a cash benefit under this Act, the amount of such benefit up to and including the day of his death shall be paid to any person nominated by the deceased person in writing in such form as may be specified in the regulations or, if there is no such nomination, to the heir or legal representative of the deceased person.

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Download ESIC REG. FORM 24 For : DECLARATION & CERTIFICATE FOR DEPENDENTS’ BENEFIT EMPLOYEES’ STATE INSURANCE CORPORATION.

Download ESIC REG. FORM 24

Download ESIC REG. FORM 24 DECLARATION & CERTIFICATE FOR DEPENDANTS’ BENEFIT EMPLOYEES’ STATE INSURANCE CORPORATION.

As per ESIC Regulation 107-A

107A.Declaration by and certificate in respect of a person claiming dependants’ benefit

Every person whose claim for any dependants’ benefit has been admitted shall submit at six-
monthly intervals, with the claim for December and June every year, a declaration and a certificate in[Form 24] attested by such authority or person and in such manner as may be specified by the Director- General.

 

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Download ESIC REG. FORM – 23For: LIFE CERTIFICATE FOR PERMANENT DISABLEMENT BENEFIT EMPLOYEES' STATE INSURANCE CORPORATION

Download ESIC REG. FORM – 23

 Download ESIC REG. FORM – 23 LIFE CERTIFICATE FOR PERMANENT DISABLEMENT BENEFIT EMPLOYEES’ STATE INSURANCE CORPORATION

As per ESIC Regulation 107

107.  Certificate in respect of a person claiming permanent disablement benefit Every person whose claim for any permanent disablement benefit has been admitted shall submit at six-monthly intervals, with the claim for December and June every year, a certificate in [Form 23] attested by such authority or persons and in such manner as may be specified by the Director-General.

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Download ESIC FORM 22 For FUNERAL EXPENSES CLAIM FORM EMPLOYEES' STATE INSURANCE CORPORATION

Download ESIC FORM 22

Download ESIC FORM 22 FUNERAL EXPENSES CLAIM FORM EMPLOYEES’ STATE INSURANCE CORPORATION

As per Regulation 95-E. Submission of claim for funeral [expenses]

(1) A claim to funeral [expenses] shall be submitted to the appropriate [branch office] by post or otherwise in [Form 22] by the claimant entitled under the Act and in case of a minor, by his guardian, and such claim shall be supported by documents proving—

(i)      the death of the deceased person,

(ii)     that the person claiming is the eldest surviving member of the family of the deceased insured person and incurred the expenditure necessary for the funeral of the deceased

(iii)  in case the claimant is other than the eldest surviving member of the family—

(a)     that the deceased insured person did not have a family or that the deceased insured person was not living with his family at the time of his death; and

(b)     that the claimant actually incurred the expenditure claimed on the funeral of the deceased insured person: PROVIDED that where the appropriate office is satisfied about the boua fides of the applicant or about the truth of the facts relating to any of the matters mentioned above, one or more of the documents may be dispensed with.

(2) The following may be accepted as proof for purposes of clauses (ii) and (iii) of sub-regulation

(1) of this regulation—

A declaration of the claimant duly countersigned by—

(i)      an officer of the Revenue, Judicial or Magisterial Departments of Government; or

(ii)     a Municipal Commissioner; or

(iii)  a Workmen’s Compensation Commissioner; or

(iv)  the Head of Gram Panchayat under the official seal of the Panchayat; or

(v)     the employers of the deceased insured person; or

(vi)  any other evidence or declaration acceptable to the appropriate office in the
circumstances of a particular case.

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