ESI Forms: Employee State Insurance Act
ESI Forms: Employee State Insurance Act
Mar 20, 2024
15 Mins
Introduction:
Under the Employee State Insurance (ESI) scheme, individuals are required to complete and submit relevant forms available on the ESIC portal to make claims. These forms include Form 72, Form 23, Form 24, Form 15, and more.
The Employees’ State Insurance (ESI) scheme is a health insurance scheme designed to safeguard the interests of workers in times of medical emergencies such as maternity, sickness, permanent or temporary physical disabilities, employment-related death, or injury leading to a loss of earnings or earning capacity. This self-financed social security scheme requires employers to contribute 4.75% and employees to contribute 1.75% of their wages.
Operating under the guidelines of the ESI Act, 1948, the ESI scheme is administered by the Employees’ State Insurance Corporation, an autonomous body under the Ministry of Labour and Employment. The scheme is intended for workers earning equal to or less than Rs.21,000 per month. It offers a range of benefits including medical, maternity, sickness, pension, dependent, disablement, and funeral and confinement expenses.
Various ESI Forms
To avail themselves of the benefits provided by the ESI scheme, beneficiaries must duly complete and submit the relevant ESI forms, accessible via the ESIC portal. Listed below are details of the various ESI forms:
- Form 72: Request for a duplicate ESIC smart card
- Form 23: Life certificate for permanent disablement benefit
- Form 24: Declaration and certificate for disablement benefit
- Form 22: Claim for funeral expenses
- Form 20: Maternity benefits claim following the death of the insured person
- Form 19: Maternity benefits claim and notice of work
- Form 16: Claim for periodical payment of disablement benefit
- Form 15: Claim for dependent benefits
- Form 14: Claim for permanent disability benefit
- Form 12: Accident report from employer
- Form 11: Accident book
- Form 9: Claim for sickness, temporary disablement benefit, and maternity benefit
- Form 6: Register of employees
- Form 5A: Advance ESIC payment for beneficiary's contribution
- Form 5: Contribution return by employee
- Form 3: Declaration return form
- Form 2: Amendment to declaration form
- Form 1: Declaration form
- Form 01: Employer's registration form
- Form 1A: Family declaration form
- Form 142: Claim for compensation for loss of earnings and conveyance allowance
- Form 105: Certificate of entitlement
- Form 86: Certificate of employment
- Form 63: Declaration form regarding payment to the legal heir
- Form 53: Application form for change in insured person's particulars
- Form 37: Certificate of re-employment or continuous employment
- Form 32: Wage-contributory record for disablement benefit
These ESI forms can be downloaded from the ESIC portal and are essential for making claims under the Employees' State Insurance scheme.
ESI Scheme Registration Process
Establishments or firms employing more than 10 individuals must register under the ESI scheme. This can be done by logging into the ESIC portal at www.esic.in and submitting the required information. Upon completion, a 17-digit code number is generated and sent to the employer's email address along with a registration form and ESIC login credentials. Using these credentials, employers can log in and provide the necessary information. In case of any registration issues, employers can contact the ESIC IT desk at itcare@esic.in.
Introduction:
Under the Employee State Insurance (ESI) scheme, individuals are required to complete and submit relevant forms available on the ESIC portal to make claims. These forms include Form 72, Form 23, Form 24, Form 15, and more.
The Employees’ State Insurance (ESI) scheme is a health insurance scheme designed to safeguard the interests of workers in times of medical emergencies such as maternity, sickness, permanent or temporary physical disabilities, employment-related death, or injury leading to a loss of earnings or earning capacity. This self-financed social security scheme requires employers to contribute 4.75% and employees to contribute 1.75% of their wages.
Operating under the guidelines of the ESI Act, 1948, the ESI scheme is administered by the Employees’ State Insurance Corporation, an autonomous body under the Ministry of Labour and Employment. The scheme is intended for workers earning equal to or less than Rs.21,000 per month. It offers a range of benefits including medical, maternity, sickness, pension, dependent, disablement, and funeral and confinement expenses.
Various ESI Forms
To avail themselves of the benefits provided by the ESI scheme, beneficiaries must duly complete and submit the relevant ESI forms, accessible via the ESIC portal. Listed below are details of the various ESI forms:
- Form 72: Request for a duplicate ESIC smart card
- Form 23: Life certificate for permanent disablement benefit
- Form 24: Declaration and certificate for disablement benefit
- Form 22: Claim for funeral expenses
- Form 20: Maternity benefits claim following the death of the insured person
- Form 19: Maternity benefits claim and notice of work
- Form 16: Claim for periodical payment of disablement benefit
- Form 15: Claim for dependent benefits
- Form 14: Claim for permanent disability benefit
- Form 12: Accident report from employer
- Form 11: Accident book
- Form 9: Claim for sickness, temporary disablement benefit, and maternity benefit
- Form 6: Register of employees
- Form 5A: Advance ESIC payment for beneficiary's contribution
- Form 5: Contribution return by employee
- Form 3: Declaration return form
- Form 2: Amendment to declaration form
- Form 1: Declaration form
- Form 01: Employer's registration form
- Form 1A: Family declaration form
- Form 142: Claim for compensation for loss of earnings and conveyance allowance
- Form 105: Certificate of entitlement
- Form 86: Certificate of employment
- Form 63: Declaration form regarding payment to the legal heir
- Form 53: Application form for change in insured person's particulars
- Form 37: Certificate of re-employment or continuous employment
- Form 32: Wage-contributory record for disablement benefit
These ESI forms can be downloaded from the ESIC portal and are essential for making claims under the Employees' State Insurance scheme.
ESI Scheme Registration Process
Establishments or firms employing more than 10 individuals must register under the ESI scheme. This can be done by logging into the ESIC portal at www.esic.in and submitting the required information. Upon completion, a 17-digit code number is generated and sent to the employer's email address along with a registration form and ESIC login credentials. Using these credentials, employers can log in and provide the necessary information. In case of any registration issues, employers can contact the ESIC IT desk at itcare@esic.in.
Author
Pluto Team
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