Need ESI Forms

Can anyone give me all the ESI forms / returns in excel format



Assistant manager for accounts

Various Types of Employee State Insurance (ESI) Forms

Form No.
Form Name
Form 01
Employer's Registration Form
Form 01(A)
Form of Annual Information on Factory/Establishment
Form 1
Declaration Form
Form 1A
Family Declaration Form
Form 1B
Changes in Family Declaration Form
Form 3
Return of Declaration Form
Form 4
Identity Card
Form 4(A)
Family Identity Card
Form 6
Return of Contributions
Form 7
First/Intermediate/Final Certificate
Form 8
Special Intermediate Certificate
Form 10
Abstention verification in r/o Sickness Benefit/Temporary Disablement Benefit/MB
Form 12
Sickness of Temporary Disablement Benefit
Form 12A
Maternity Benefit for Sickness
Form 13
Sickness or Temporary disablement or maternity benefit for sickness
Form 13A
Maternity Benefit for Sickness
Form 14
Sickness or temporary disablement or maternity benefit for sickness
Form 14A
Maternity Benefit for Sickness
Form 16
Accident report from employer
Form 17
Dependant's or funeral benefit (Death Certificate)
Form 18
Dependant's Benefit (Claim Form)
Form 18A
Dependant's Benefit (Claim for periodical payments)
Form 19
Maternity Benefit (Notice of Pregnancy)
Form 20
Maternity Benefit (Certificate of Pregnancy)
Form 21
Maternity Benefit (Certificate of expected confinement)
Form 22
Claim for Maternity Benefit
Form 23
Maternity Benfit (Certificate of confinement or miscarriage)
Form 24
Maternity Benfit (Notice of Work)
Form 25
Claim for permanent Disablement Benefit
Form 26
Certificate for Permanent Disablement Benefit
Form 27
Declaration and Certificate for depenant's benefit
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


Thanks a lot Mahes Rajarajan

Audit Assistant

Any changes in ESI


Dear All

Our office is situated at st.johns Road, Bangalore - 560 042. we need to take ESI Code, Please let us know which  ESIC Office we have to go for Registration, I Mean address of the ESIC office, Regards.




Your are not logged in . Please login to post replies

Click here to Login / Register