Category: ESIC Forms

Download ESIC FORM 5 RETURN OF CONTRIBUTIONS EMPLOYEES’ STATE INSURANCE CORPORATION

As per ESIC Regulation 26

26. Return of contributions to be sent to appropriate office

(1) Every employer shall send a return of contributions in quadruplicate in [Form 5] along with receipted copies of challans for the amounts deposited in the Bank, to the appropriate office by registered post or messenger, in respect of all employees for whom contributions were payable in a contribution period, so as to reach that office as —

[(a) Within 42 days of the termination of the contribution period to which it relates;

(b) Within 21 days of the date of permanent closure of the factory or establishment, as the case maybe];

(c) Within 7 days of the date of receipt of requisition in that behalf from the appropriate office.

(2) For the purposes of section 77 of the Act, the due date by which the evidence of contributions
having been paid must reach the Corporation shall be the last of the days respectively specified in clauses (a), (b) and (c) of sub-regulation (1).]

Download ESIC Form 3 Employee’ STATE INSURANCE CORPORATION Return of Declaration Form

As per ESIC Regulation 14  Declaration form to be sent to appropriate officeThe employer shall send to the appropriate office by registered post or messenger, all declaration forms without detaching the temporary identification certificate prepared under these regulations together with a return in duplicate in Form 3 within 10 days of the date on which the particulars for the declaration forms were furnished.

Download ESIC FORM – 2

As per ESIC Regulation 15B)

15B. Changes in familyAn insured person shall intimate all changes in the membership of the family as defined under the Act, to the employer within 15 days of such change having occurred and the employer shall enter such particulars in [Form 2] and shall forward it to the appropriate office within 10 days of the date on which the particulars were furnished.

Download ESIC FORM 1A

 Download ESIC FORM 1A FAMILY DECLARATION FORM

As per ESIC Regulation 15A. Registration of families

On the issue of notification under regulation 95A, specifying the date from which the famAily of an insured person shall also be entitled to medical benefit under the Act, every insured person who has not furnished the particulars of his family at the time of his registration under the Act, shall furnish to the employer correct particulars [along with their photographs] in respect of his family in Form 1A. The employer shall enter the particulars in the form and obtain the signature or the thumb-impression of such person and complete the form as indicated thereon and send it to the appropriate office within 10 days of the date on which the particulars were furnished.

 Download ESIC FORM – 1

As per ESIC Regulations 11 & 12

11.     Declaration by persons in employment on appointed dayThe employer in respect of a factory or an establishment shall require every employee in such factory or establishment to furnish and such employee shall on demand furnish to him either before or on the appointed day correct particulars [alongwith his/her photograph and that of his/her family] required for the purpose of Form 1 (hereinafter referred to as the Declaration Form). Such employer shall enter the particulars in the Declaration Form including the Temporary Identification Certificate, and obtain the signature or the thumb-impression of such employee and also complete the form as indicated thereon.

12.     Declaration by persons engaged after the appointed day(1) The employer in respect of a factory or an establishment shall, before taking any person into employment in such factory or establishment after the appointed day, require such person (unless he can produce an Identity Card or other document in lieu thereof issued to him under these regulations) to furnish and such person shall on demand furnish to him correct particulars [alongwith his/her photograph and that of his/her family] required for the Declaration Form including the Temporary Identification Certificate. Such employer shall enter the particulars in the Declaration Form including the Temporary Identification Certificate and obtain the signature or the thumb-impression of such person and also complete the form as indicated thereon.

(2) Where an Identity Card is produced under such sub-regulation (1), the employer shall make relevant entries thereon.

Download ESIC FORM 01(A)

Download ESIC FORM 01(A) FORM OF ANNUAL INFORMATION OF FACTORY/ ESTABLISHMENT COVERED UNDER ESI ACT As per Regulation 10C. Submission of annual information by factories/establishments

The employer in respect of a factory or establishment to which this Act applies and to whom a code number has already been allotted, shall furnish to the appropriate Regional Office or Sub-Regional Office or Divisional Office, by 31st of January every year, a return in Form 01-A. The employer shall be responsible for correctness of all particulars and information furnished in Form 01-A.

Download ESIC FORM 01 For EMPLOYERS’ REGISTRATION FORM                                      

As per ESIC Regulation 10-B. 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.