Home ESI ADVISOR Types Of ESI Claim Forms

Types Of ESI Claim Forms

ESI or Employees’ State Insurance is a health insurance scheme which protects workers during medical emergencies. The employee contributes 4.75% of his salary towards this scheme. Meanwhile, the employer contributes 1.75% of the employee’s salary. The Employees’ State Insurance Corporation is an autonomous body working under the Ministry of Labour and Employment. They manage the ESI scheme. The ESI scheme follows the ESI Act, 1948 guidelines. It provides benefits for medical, maternity, sickness, pension, dependent, disability and funeral, and confinement expenses. In this article, we will discuss all the types of ESIC forms claim which are available and their usage.

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ESIC Forms claim List:

  1. Form 1 – This is a declaration form. Whenever a new Insured Person (IP) joins a company then all of his, as well as his family details, are filled up via this form and given to the employer. This is also available on the ESI online portal for viewing. Keep a copy of this form to reproduce it during an inspection or another reason.
  2. Form 9 – This form is used for making claims for sickness, temporary disablement benefit, and maternity benefit. Fill up the form and send it to the ESIC for getting claim benefits.
  3. Form 11 & 12 – Form 11 is called accident book while Form 12 is an accident report from the employer. The employer has to fill these up when an IP has an accident while working at his company.
  4. Form 14 – This is an ESI claim form for permanent disability benefit. If an employee has an accident while working which renders him disable or unable to work in future, then this ESI claim form is submitted to receive ESI benefits.
  5. Form 15 – This is a form helps with making claims for availing dependent benefits. If an IP dies while working in a factory then his nominee can get the lumpsum ESI benefit via this form.
  6. Form 16 – For making claims for periodical payment of disablement benefit, this form can be used. If an IP dies while working in a factory then his nominee can receive periodical ESI benefits via this form.
  7. Form 19 – In order to claim maternity benefits and submit your maternity leave, this form has to be submitted.
  8. Form 20 – This form helps with availing maternity benefits in case of the death of the insured pregnant woman. Additionally, view this blog to get all the details for this.
  9. Form 22 – This form helps with making a claim for the funeral expenses of an IP. The funeral fund was increased from Rs 10,000 to Rs 15,000.
  10. Form 23 – This form is a life certificate form for the dependent’s benefit. The IP’s dependent has to annually produce his life certificate to the ESIC to keep receiving the ESI benefits.
  11. Form 24 – This form is a declaration form which the dependent has to submit to prove that he has neither remarried nor is receiving monetary benefits from another source.
  12. Form 32 – ESI contribution records of the IP which the employer has to submit to the ESIC. This helps correctly calculating the dependent’s benefit.
  13. Form 37 & 7A – Certificate of sickness and fitness for continuous employment. You can view this in detail here.
  14. Form 142 – This form helps with making claims for compensation for loss of a day’s wage and conveyance allowance.

ESI Claim Process:

To make claims under the ESI scheme, the beneficiaries have to submit the relevant ESIC forms claim after duly filling it. All of the above-mentioned ESI claim forms are available to download from the ESIC portal.

If you still want some clarification then watch the video below and drop your question in the comments section:

Similarly, find our previous article on all important PF forms.

Other helpful blogs related to ESIC which you can browse through:

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3 COMMENTS

  1. Dear Sir,

    Thanks for giving us the useful information.

    Kindly note that the Employer contribution is 4.75% and Employee contribution 1.75%.

    Kindly get it corrected.

  2. My esi form 23 is lost from esi office while sending through ordinary post.what shall i do now? Can an attested copy help me or not?

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