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Forms for employer
Sl No. Name of Form Purpose of Form

1

 Form-01  Employers Registration form

2

 Form-01(A)  Annual information on fact/Estt. Submission form

3

Form 3

  Return of Declaration forms

4

 Form 5  Return of contributions

5

 Form 5A  Statement of advance payment of contribution

6

 Form 10  Abstention verification form

7

 Bank Challan  For depositing Contribution./
 interest/Damages etc.

8

 ESIC-32  Wage/ Contributory record for Disablement Benefit
Forms for employees
Sl No. Name of Form Purpose of Form

1

 Form 1  Declaration Form

2

 Form 2  Addition/ Deletion in Family declaration form

3

 Form 9  Claim form for Sickness/ TDB/ Maternity

4

 Form 12  Accident Report

5

 Form 14  Claim form Permanent Disablement Benefit (PDB)

6

 Reg. Form - 15  Claim form for Dependant Benefit (DB)

7

 Reg. Form -16  Claim form for periodical payments of DB

8

 Reg. Form -19  Claim for Maternity Benefit

9

 Reg. Form -20  Claim form for Maternity Benefit after death of child

10

 Reg. Form -22  Claim form for Funeral Expenses

11

 Reg. Form -23  Life Certificate

12

 Reg. Form -24  Dependant Benefits declaration.

13

 ESIC-37  Certificate of re-employment/ Continuing employment

14

 ESIC-53  Change of Branch Office/ Dispensary
15 ESIC-72  Duplicate Identity Card Application
16    Feedback Form
17 UA1  Claim For Unemployment Allowance
18 UA2  Certificate of unemployment due to retrenchment/ closure of  factory/ permanent invalidity arising out of non-employment injury  to the extent of 50% or more.
19 UA9  Periodical Claim Form For Unemployment Allowance
 
 
 

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