ESI
ESI
Form No.

Form 01

Description
Employer’s Registration Form
Relevant Regulation
10B
To be used by
Employer
Time limit of depositing the Form
Furnished to regional office not later than 15 days after the act becomes applicable.
Penalty
Blank

Form 01

Description
Intimation for Change in declaration submitted under FORM-01.
Relevant Regulation
10C
To be used by
Employer
Time limit of depositing the Form
Within 2 Weeks of such Change.
Penalty
Blank

Form-1

Description
Declaration Form- for furnishing particulars along with his/her photograph and that of his/her family
Relevant Regulation
11 & 12
To be used by
Employer
Time limit of depositing the Form
No time limit prescribed.
Penalty
Blank

Form-1A

Description
Family Declaration Form-for which the family of an insured person is entitled to medical benefit under the Act.
Relevant Regulation
15A
To be used by
Employer
Time limit of depositing the Form
Send to the appropriate office within ten days of the date on which the particulars were furnished
Penalty
Blank

Form 2

Description
Addition & Deletion in Family Declaration Form
Relevant Regulation
15B
To be used by
Employer
Time limit of depositing the Form
Send to the appropriate office within ten days of the date on which the particulars were furnished.
Penalty
Blank

Form 3

Description
Return of Declaration Form
Relevant Regulation
14
To be used by
Employer
Time limit of depositing the Form
Within 10 days of the date on which the particulars for the Declaration Forms were furnished
Penalty
Blank

Form 5

Description
Return of Contribution (In Quadruplicate) with receipted copies of challans for the amounts deposited in the Bank.
Relevant Regulation
26
To be used by
Employer
Time limit of depositing the Form
  • (a) within 42 days of the termination of contribution period to which it relates
  • (b) within 21 days of the date of permanent closure of the factory or establishment, as the case may be
  • (c) within 7 days of the date of receipt of requisition in that behalf from the appropriate office.
Penalty
Blank

Form 5A

Description
Advance Payment of Contribution
Relevant Regulation
31
To be used by
Employer
Time limit of depositing the Form
Within 21 days of the last day of the calendar month in which the contributions fall due.
Penalty
Blank

Form 6

Description
Register of Employees
Relevant Regulation
32
To be used by
Employer
Time limit of depositing the Form
Not Prescribed.
Penalty
Blank

Form 9

Description
Claim for Sickness/Temporary Disablement benefit
Relevant Regulation
63 & 89(B)
To be used by
IP/ Beneficiary
Time limit of depositing the Form
Not Prescribed.
Penalty
Blank

Form 11

Description
Accident Book
Relevant Regulation
66
To be used by
Employer
Time limit of depositing the Form
N.A.
Penalty
Blank

Form 12

Description
Accident Report From Employer
Relevant Regulation
68
To be used by
Employer
Time limit of depositing the Form
N.A.
Penalty
Blank

Form 14

Description
Claim for Permanent Disablement benefit
Relevant Regulation
76(A)
To be used by
IP/ Beneficiary
Time limit of depositing the Form
N.A.
Penalty
Blank