| FORM NO |
PURPOSE |
| ESI Challan |
Challan for
deposit |
| ESI Photo I-Card Form |
ESI Photo Identity
Card Form |
| ESI 105 / ESI MED-10 |
Certificate of
Entitlement / Application for Medical Treatment as Temporary
Resident |
| Form 01 1 2 3 4 |
ESI Registration
Form (Regulation 10B) |
| Form 1 Front Back |
ESI Declaration
Form (Regulations 11 & 12) (To be filled in only if the
employee is not insured earlier) |
| Form 1-B |
Change in Family
Declaration Form (Regulation 15-B) |
| Form 3 |
Return of
Declaration Form (Regulation 14)(To be submitted in
duplicate) |
| Form 6 |
Return of
Contribution Form (Regulations 26) (To be submitted in
Quadruplicate) |
| Form 12, 13 & 14 |
Sickness
or Temporary Disablement Benefit (Form 12) / Sickness or
Temporary Disablement or Maternity Benefit for Sickness (Form
13 & 14) |
| Form 37 |
Certificate of
re-employment/continuing employment |
| Form 53 |
Application for
Change in particulars of insured person |
| Form 86 |
Certificate of
Employment |
| Form16 Accident Report |
a brief report of
the accident which took place submitted to the local
office |
