ESIC Services
Dear Employer, Online Payment of ESI Contribution Made Easier. Now, facility for payment of ESI contributaion is available through net banking of State Bank of India (SBI) and 58 major banks w.e.f. 1st April, 2015. For more information, visit nearest ESIC office or log on ESIC websites '', ''


FORM-01 Employer's Registration Form 10 B Employer
FORM-01(A) Form of annual information on factory/establishment covered under ESI Act 10 C Employer
FORM-1 Declaration Form 11 & 12 Employer
FORM-1(A) Family Declaration Form 15-A Employer
FORM-2 Addition/Deletion in Family Declaration Form 15-B Employer
FORM-3 Return of Declaration Form 14 Employer
FORM-5 Return of Contribution 26 Employer
FORM-5(A) Advance payment of contribution 31 Employer
FORM-5 (New) Return of Contribution (New) 31 Employer
FORM-6 Register of Employees 32 Employer
FORM-9 Claim for Sickness/ Temporary Disablement Benefit/Maternity Benefit 63 & 89(B) IP/Beneficiary
FORM-11 Accident Book 66 Employer
FORM-12 Accident Report from Employer 68 Employer
FORM-14 Claim for Permanent Disablement Benefit 76(A) IP/Beneficiary
FORM-15 Claim for Dependent Benefit 80 IP/Beneficiary
FORM-16 Claim for periodical payment of Dependent Benefits 83(A) IP/Beneficiary
FORM-19 Claim for Maternity Benefit and notice of work 88, 89 & 91 IP/Beneficiary
FORM-20 Claim for Maternity Benefit after the death of an Insured Women leaving behind the child 89(A) IP/Beneficiary
FORM-22 Funeral Expenses Claim 95(E) Beneficiary
FORM-23 Life Certificate for Permanent Disablement Benefit 107 IP/Beneficiary
FORM-24 Declaration and Certificate for Dependents Benefit 107(A) IP/Beneficiary
ESIC-32 Wage/Contributory record for disablement benefit Employer
ESIC-37 Certificate of re-employment/continuous employment Employer
ESIC-53 Application for change in particulars of Insured Persons regarding change of Branch Office/Dispensary IP/Beneficiary
ESIC-63 Declaration form regarding payment to the legal heir/representative of the deceased IP IP/Beneficiary
ESIC-71 Particulars of contribution in case Return of Contribution in respect of an IP not sent Employer
ESIC-72 Application for duplicate Identity Card IP/Beneficiary
ESIC-86 Certificate of Employment Employer
ESIC-105 Certificate of Entitlement Employer
ESIC-126 Certificate of continuous employment for Extended Medical and Sickness Benefit Employer
ESIC-142 Claim for conveyance allowance and/or compensation for loss of wages for an IP appeared before the medical board IP/Beneficiary
C-1,2 & 6 Proforma for Survey Register  
C-18, Actual, Interest, C-19, 20, 22 & 23, D-18 & D-19 Proformas  
C-2 to C-5 & C-7 to C-12 Proformas