Pocket Information about Employees’ State Insurance Act, 1948
Calculations of ESI: ESI from Gross
Employee: 1.75%
Employer: 4.75%
Coverage: All the employees Drawing wages up to Rs.15, 000/- per month engaged either directly or thru’ contractor.
Expected activities:
1. Time of joining/at any time:
Form 01 : Employer Registration Form
Form 1 : Employee should fill, at the time of joining, Declaration form with postcard size
Photograph – due date within 10 days after the employees joins.
Form 1 A : Family Declaration Form, family details
Form 1 B : Changes in family declamation form, like family members…
Form 3 : Return of declaration form (Covering Letter) 3A continuation sheet/card,
Employer should fill. Male and female separately
Form 37: Employer should fill Certificate of Re-Employment / Continuing employment. With
Contribution period begin and end dates.
Form 105: Employer should fill, Certificate of Entitlement.
Form 72: Employee should fill, Application /form for changes in particular of insured
Person. Like local office, Dispensary/Address changes.
Register 7 : Individual Computation, there Gross salary, Days, ESI amt.
Information maintains month-wise.
Cards: Temporary & Permanent Cards.
Monthly Remittance / Challans:
1. Challans every month before 21st (3 copies/ quadruplicate)
2. Submit to Bank
3. Both employer & employee contribution
4. Cheque details.
Half year returns:
Contribution period:
1st April to 30th September.
1st October to 31st March
***42 days after closing Contn. Period (before Nov 11th. and next before May 12th)
1. Form 7 (Register of Employees)
2. Form 6A: Consolidated Computation Sheet, contains total employees list, there total half
Yearly Information. Form 6 is top sheet and 6A is attachments. (Statement of
Advance Payment of Contributions)
2. In Oct & April
3. With all paid challans
Need to maintain under ESI ACT:
* Muster Roll * Wage Register * Inspection Book * Accident Register * Cash Books, Vouchers & Ledgers * Paid Challans, RDF and Declarations
* Returns copies
Various Forms under ESI Act:
Form 4 : Identity Card
Form 4 A : Family Identity Card
Form 6 : Return of Contributions
Form 8 : First Medical Certificate
Form 9 : Final Medical Certificate
Form 10 : Intermediate Medical Certificate
Form 11 : Special Intermediate Certificate
Form 12 : Sickness Or Temporary Disablement Benefit / Claim For Benefit – Form
From 12 A : Maternity Benefit For Sickness / Claim For Benefit – Form
Form 13 : Sickness or Temporary Disablement or Maternity Benefit for Sickness / Claim For
Benefit – Form
Form 13 A : Claim For Maternity Benefit For Sickness – Form
Form 14 : Sickness Or Temporary Disablement Or Maternity Benefit For Sickness / Claim For
Benefit - Form
Form 14A: Claim For Maternity Benefit For Sickness
Form 15: Accident Book – Form
Form 16: Employer should fill, accident report form, with date of accident, place, time…need to
Submit to ESI local office immediately – 3 Copies (with 2 witness) 1-Local office,
Form 17: Death Certificate – Form
Form 18: Dependants Benefit - Claim Form
From 18A: Defendants Benefit/ Claim Form for periodical payments – Form
Form 19: Notice of Pregnancy – Form
Form 20: Certificate of pregnancy – Form
Form 21: Certificate of Expected Confinement – Form
Form 22: Benefit Claim Form
Form 23: Certificate of Confinement or Miscarriage
Form 24: Notice of Taking Up Work – Form
Form 24 A: Maternity Benefit Claim After The Death Of An Insured Woman Leaving Behind The
Child – Form
Form 24 B: Maternity Benefit Death Certificate – Form
Form 25: Claim for Permanent Disablement Benefit – Form
Form 25 A: Funeral Expenses Claim Form
Form 26: Certificate for Permanent Disablement Benefit – Form
Form 27: Declaration and Certificate for Dependants’ Benefit - Form
Form 28: Confirmation of Incapacitation of Employee - Form
Form 28 A: Confirmation of Incapacitation of Employee - Form
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