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 size:(14.1 KB) 10 B Employer
FORM-01(A) Form of annual information on factory/establishment covered under ESI Act size:(35.7 KB) 10 C Employer
FORM-1 Declaration Form size:(42.9 KB) 11 & 12 Employer
FORM-1(A) Family Declaration Form size:(32.0 KB) 15-A Employer
FORM-2 Addition/Deletion in Family Declaration Form size:(70.5 KB) 15-B Employer
FORM-3 Return of Declaration Form size:(32.9 KB) 14 Employer
FORM-5 Return of Contribution size:(39.6 KB) 26 Employer
FORM-5(A) Advance payment of contribution size:(33.5 KB) 31 Employer
FORM-5 (New) Return of Contribution (New) 31 Employer
FORM-6 Register of Employees size:(41.0 KB) 32 Employer
FORM-9 Claim for Sickness/ Temporary Disablement Benefit/Maternity Benefit size:(41.3 KB) 63 & 89(B) IP/Beneficiary
FORM-11 Accident Book size:(34.5 KB) 66 Employer
FORM-12 Accident Report from Employer size:(42.1 KB) 68 Employer
FORM-14 Claim for Permanent Disablement Benefit size:(24.6 KB) 76(A) IP/Beneficiary
FORM-15 Claim for Dependent Benefit size:(100 KB) 80 IP/Beneficiary
FORM-16 Claim for periodical payment of Dependent Benefits size:(40.8 KB) 83(A) IP/Beneficiary
FORM-19 Claim for Maternity Benefit and notice of work size:(38.8 KB) 88, 89 & 91 IP/Beneficiary
FORM-20 Claim for Maternity Benefit after the death of an Insured Women leaving behind the child size:(32.3 KB) 89(A) IP/Beneficiary
FORM-22 Funeral Expenses Claim size:(32.8 KB) 95(E) Beneficiary
FORM-23 Life Certificate for Permanent Disablement Benefit size:(40.6 KB) 107 IP/Beneficiary
FORM-24 Declaration and Certificate for Dependents Benefit size:(44.2 KB) 107(A) IP/Beneficiary
ESIC-32 Wage/Contributory record for disablement benefit size:(44.6 KB) Employer
ESIC-37 Certificate of re-employment/continuous employment size:(20.2 KB) Employer
ESIC-53 Application for change in particulars of Insured Persons regarding change of Branch Office/Dispensary size:(15.1 KB) IP/Beneficiary
ESIC-63 Declaration form regarding payment to the legal heir/representative of the deceased IP size:(22.0 KB) IP/Beneficiary
ESIC-71 Particulars of contribution in case Return of Contribution in respect of an IP not sent size:(35.9 KB) Employer
ESIC-72 Application for duplicate Identity Card size:(32.7 KB) IP/Beneficiary
ESIC-86 Certificate of Employment size:(18.5 KB) Employer
ESIC-105 Certificate of Entitlement size:(19.4 KB) 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 size:(39.0 KB) IP/Beneficiary
C-1,2 & 6 Proforma for Survey Register size:(55.6 KB)  
C-18, Actual, Interest, C-19, 20, 22 & 23, D-18 & D-19 Proformas size:(231 KB)  
C-2 to C-5 & C-7 to C-12 Proformas size:(162 KB)