1. Details of Employee State Insurance and Provident Fund
1. ESIC Challans
2. P.F.Challans
3. Nomination and Declaration (Form 2)
4. P.F. (Form 5,10 & 12A)
5. PF annual returns ( form 6A and 3A)
6. Payment of wages act (Form IV)
7. Maternity benefit Act (Form K,L,M, & N)
8. Halfyearly returns of ESIC (Form 6)
9. ESIC forms for newly joining covered under ESIC (Form 3)
10. PF (Form 13 for transfer of PF account)
ESI Act
The promulgation of Employees’ State Insurance Act, 1948 envisaged an integrated need
based social insurance scheme that would protect the interest of workers in contingencies
such as sickness, maternity, temporary or permanent physical disablement, death due to
employment injury resulting in loss of wages or earning capacity. the Act also guarantees
reasonably good medical care to workers and their immediate dependants.
Following the promulgation of the ESI Act the Central Govt. set up the ESI Corporation to
administer the Scheme. The Scheme, thereafter was first implemented at Kanpur and Delhi
on 24th February 1952. The Act further absolved the employers of their obligations under
the Maternity Benefit Act, 1961 and Workmen’s Compensation Act 1923. The benefit
provided to the employees under the Act are also in conformity with ILO conventions.
ESIC CONTRIBUTION
E.S.I. Scheme being contributory in nature, all the employees in the factories or
establishments to which the Act applies shall be insured in a manner provided by the
Act. The contribution payable to the Corporation in respect of an employee shall
comprise of employer’s contribution and employee’s contribution at a specified rate. The
rates are revised from time to time. Currently, the employee’s contribution rate
(w.e.f. 1.1.97) is 1.75% of the wages and that of employer’s is 4.75% of the
wages paid/payable in respect of the employees in every wage period. Employees in
receipt of a daily average wage upto Rs.70/- are exempted from payment of
contribution. Employers will however contribute their own share in respect of these
employees.
The State Governments, as per provisions of the Act, contribute 1/8th of the
expenditure of medical benefit within a per capita ceiling of Rs. 1200/- per
Insured Person per annum.
Collection of Contribution
An employer is liable to pay his contribution in respect of every employee and deduct
employees contribution from wages bill and shall pay these contributions at the above
specified rates to the Corporation within 21 days of the last day of the Calendar month in
which the contributions fall due. The Corporation has authorized designated branches of the
State Bank of India and some other banks to receive the payments on its behalf.
Contribution Period and Benefit Period
There are two contribution periods each of six months duration and two corresponding
benefit periods also of six months duration as under.
Contribution period Corresponding Cash Benefit period
Contribution Period Cash Benefit Period

2. 1st April to 30th Sept. 1st January of the following year to 30th June.
1st July to 31st December of the year
1st Oct. to 31st March
following
BENEFITS
The section 46 of the Act envisages following six social security benefits :-
(a) Medical Benefit : Full medical facilities for self and family from day one of entering
insurable employment.
(b) Sickness Benefit(SB) : Payment of contribution for 78 days in corresponding
contribution period of six months.
1. Extended Sickness Benefit(ESB) : Same as above
2. Enhanced Sickness Benefit : For 34 specified long term diseases, Continuous
insurable employment for two years with 156 days contribution in four consecutive
contribution periods.
(c) Maternity Benefit(MB)
(d) Disablement Benefit
1. Temporary disablement benefit (TDB) : From day one of entering insurable
employment & irrespective of having paid any contribution in case of death due to
employment injury.
2. Permanent disablement benefit (PDB) : Same as above
(e) Dependants’ Benefit(DB) : From day one of entering insurable employment &
irrespective of having paid any contribution in case of death due to employment injury.
(f) Other Benefits :
- Funeral Expenses : An amount of Rs. 5000/- is payable to the dependents or to the person
who performs last rites from day one of entering insurable employment.
- Confinement Expenses : An Insured Women or an I.P.in respect of his wife in case
confinement occurs at a place where necessary medical facilities under ESI Scheme are not
available.
In addition, the scheme also provides some other need based benefits to insured
workers.
- Vocational Rehabilitation : In case of physical disablement due to employment injury.
- Physical Rehabilitation : In case of physical disablement due to employment injury.
- Rajiv Gandhi Shramik Kalyan Yojana - This scheme of Unemployment allowance was
introduced w.e.f. 01-04-2005. An Insured Person who become unemployed after being
insured three or more years, due to closure of factory/establishment, retrenchment or
permanent invalidity are entitled to :-
• Unemployment Allowance equal to 50% of wage for a maximum period of upto one
year.
• Medical care for self and family from ESI Hospitals/Dispensaries during the period IP
receives unemployment allowance.
• Vocational Training provided for upgrading skills - Expenditure on fee/travelling
allowance borne by ESIC.
An interesting feature of the ESI Scheme is that the contributions are related to the paying
capacity as a fixed percentage of the workers wages, whereas, they are provided social
security benefits according to individual needs without distinction.
Cash Benefits are disbursed by the Corporation through its Branch Offices (BOs) / Pay
Offices (POs), subject to certain contributory conditions.

3. VARIOUS TYPES OF ESI FORMS :
Various Types of Employee State Insurance (ESI) Forms
Form No.
Form 01 Form
Employer's Registration Form View and Download
Name
Form 01(A) Form of Annual Information on View and Download
Factory/Establishment
Form 1 Declaration Form View and Download
Form 1A Family Declaration Form View and Download
Form 1B Changes in Family Declaration Form View and Download
Form 3 Return of Declaration Form View and Download
Form 4 Identity Card View and Download
Form 4(A) Family Identity Card View and Download
Form 6 Return of Contributions View and Download
Form 7 First/Intermediate/Final Certificate View and Download
Form 8 Special Intermediate Certificate View and Download
Form 10 Abstention verification in r/o Sickness View and Download
Benefit/Temporary Disablement Benefit/MB
Form 12 Sickness of Temporary Disablement Benefit View and Download
Form 12A Maternity Benefit for Sickness View and Download
Form 13 Sickness or Temporary disablement or View and Download
maternity benefit for sickness
Form 13A Maternity Benefit for Sickness View and Download
Form 14 Sickness or temporary disablement or View and Download
maternity benefit for sickness
Form 14A Maternity Benefit for Sickness View and Download
Form 16 Accident report from employer View and Download
Form 17 Dependant's or funeral benefit (Death View and Download
Certificate)
Form 18 Dependant's Benefit (Claim Form) View and Download
Form 18A Dependant's Benefit (Claim for periodical View and Download
payments)
Form 19 Maternity Benefit (Notice of Pregnancy) View and Download
Form 20 Maternity Benefit (Certificate of Pregnancy) View and Download
Form 21 Maternity Benefit (Certificate of expected View and Download
confinement)
Form 22 Claim for Maternity Benefit View and Download
Form 23 Maternity Benfit (Certificate of confinement View and Download
or miscarriage)
Form 24 Maternity Benfit (Notice of Work) View and Download
Form 25 Claim for permanent Disablement Benefit View and Download
Form 26 Certificate for Permanent Disablement View and Download
Benefit
Form 27 Declaration and Certificate for depenant's View and Download
benefit
If you feels any
difficulty
regarding
completion and
submission of
these forms
please Contact

4. Us
FORMS FOR CLAIMING BENEFITS UNDER THE EMPLOYEES' PROVIDENT
FUND SCHEME
FORMS FOR CLAIMING BENEFITS UNDER THE EMPLOYEES' PROVIDENT
FUND SCHEME
Form No.
13 For transferring the Provident Fund account
(Revised)Purp of a member from one establishment to
View and Download
ose another establishment covered under the act /
scheme.
19 To be submitted by a member to withdraw his View and Download
Provident Fund dues on leaving
service/retirement/termination.
20 In the event of death of member, this form is View and Download
to be used by a nominee / family member to
claim the member's Provident Fund
accumilation.
31 For the use of Provident Fund members to View and Download
avail advances / withdrawals as provided in
the scheme.
FORMS FOR
CLAIMING
BENEFITS
UNDER THE
EMPLOYEES
' PENSION
SCHEME '95
Form No.
10-CPurpose For claiming :
- Refund of Employer share.
- Withdrawl benefit View and Download
- Scheme certificate for retention of
membership
10-D To be submitted by the first claimant i.e. View and Download
- member or
- widow/widower or
- orphan or
- nominee as the case may be
FORMS FOR
WITHDRAW
AL OF
INSURANCE
FUNDS
BENEFITS
UNDER
EMPLOYEES

5. ' DEPOSIT
LINKED
INSURANCE
SCHEME,
1976
Form No.
5 To be preferred by the person eligible to View and Download
(I.F.)Purpose receive the Employees' Provident Fund dues
of the deceased member who died while in
services.
If you feels any
difficulty
regarding
completion and
submission of
these forms
please Contact
Us