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PDB is payable to an employee who suffers from permanent disablement as a result of EI (including Occupational Diseases) and which results in loss of earning capacity. Authority for examing the loss of capacity of the earning for injuries is the Medical Board and in the case of Occupational Diseases, Special Medical Board. The benefit is paid at the rate of 90% of wage in the form of monthly payment depending upon the extent of loss of earning capacity as certified by a Medical BoardDownload Form
10 C is the submission of the annual details submitted by the establishments to the ESIC.It is the responsibility of the employer to whom the code allotted should furnish to the Sub Regional Office, Division Office by the 31st of January of every year. Employer will be responsible to all details mentioned in the Form 01ADownload Form
The form is to be submitted by the employee to the employee to claim the benefit of the sickness during the pregnancy.Download Form
Form to be submitted by the employee to the employer with all complete details required in the form to claim the sickness, temporary disablement, or maternity benefit.Download Form
The form is used by the dependent of the insured person to receive the benefits of periodically payment.Download Form
Form is to be submitted by the employee to the employer mentioning the expected confinement period. Confinement-payable for a period of 12 weeks (84 days) on production of Form 21.Download Form
The form is used to avail the dependent's benefits, the claimant can submit the declaration - cum -certificate at the ESIC office.Download Form
The form is used to obtain the Life certificate to avail of Permanent Disability Benefit.The certificate is need to be attested by any of the following : - an officer of the Revenue, Judicial, or Magisterial Department - a Municipal Commissioner - a Workmens Compensation Commissioner - the Head of Gram Panchayat under the official seal of Panchayat - an M.L.A./M.P. - a Gazetted Officer of the Central/State Govt. - a member of the Regional Board/Local Committee of the ESIC - any other authority considered appropriate by the Branch Manager concernedDownload Form
ESIC has introduced Form 22 to claim the funeral expense of a deceased ESIC member. Family members /nominee needs to submit the filled/attested form at ESIC office within the 6 months of death to claim it. The form is effective from March 1, 2019 family member can claim from rs-10,000/- to 15,000/- as funeral expenses from ESIC OfficeDownload Form
In case of insured woman if death occurs after leaving the child behind nominee can claim the benefit .
Form to be submitted within the 30 days of death after attestation at the branch office with the death certificate of the member.
ESIC claim form 19 has to be submitted to the employer by the insured pregnant woman in order to claim payment of maternity benefits.ESIC maternity claim form consists details like name of the insured woman,
ESIC IP number, the address of the pregnant woman, working department of the insured woman and present employer name.No work for remuneration shall be taken up during the period for which Maternity Benefit is being claimed or is to be claimed.Download Form
Employer has to report the accident to the nearest ESI Branch Office in prescribe time limit.Submit report immediately within 24 hours of its occurrence as if the injury is serious i.e. it is likely to cause a death or permanent disablement or loss of a member
Now, it can be submitted online also as ESIC introduced the facility at ESI Employer Portal.
Employers can get the Form-11 to furnish accident injury details.Every employer shall keep an accident book in which the any particulars of any accident causing personal injury to an insured person may be mentioned.
ESI Form 3 is a Return of Declaration form to be submitted during each month with the details of the Employees working in the purview of ESI during the given month.
Employer shall send a return of Declaration Forms in the given fomat, in
duplicate, within 10 days from the date on which the declaration Forms
Form 2 is used to add or remove the beneficiaries in the portal from availing the medical benefit.Family Members of IP who can avail benefit (his/her) :
- Spouse (his/her)
- Minor Dependent Son Up to 25 Years
- Dependant Unmarried Daughter Up to 25 Years
- Dependant Infirm Son by reason of any physical or mental abnormality or injury
- Dependant Infirm Unmarried Daughter
- Dependant Father
- Dependant Mother
- Minor Brother ( When there are no parents)
- Minor Sister (When there are no parents)
It is submitted to claim the sickness, temporary disablement,
or maternity benefit, the employee needs to submit this form to the linked
As per the ESI act, 1948 if any person gives a false
statement or misrepresentation to obtain benefit whether for self/another
person shall be punishable with imprisonment of up to 6 months or with a fine
of up to Rs. 2,000/-, or both.
Any employee working in the PF covered Establishment and he
is registered under the Employees Provident Fund is automatically get enrolled
for Employee’s Pension scheme if his Salary is below Rs.15000/-
as per new updated rule. Under this scheme, employees are eligible to claim and get pension
after retirement at the age of 58 years. However, an employee has the option to get
a reduced pension after 50 years at a discounted rate of 4% each year. Form 10
D is filled by the registered employee to enroll his name for withdrawal of
Below Eligible person can claim Pension by submitting Form 10
EmployeeWidow or WidowerMajor or OrphanGuardianNomineeDependant ParentsLegal heir
Employer files a return with particulars of ownership in the Form 5A (Revised) showing the particulars of all the Owners, Directors, Partners, Trustees and Authorized Signatories who have the authority and control to take decisions regarding the establishment. It is mandatory to submit the PF Form 5A (Revised) Online on Unified Employer Portal.
However, In some cases EPFO allow to submit the PF Form 5A (Revised) offline. Download the Format to fill the detail in Form 5A (Revised) correctly.Download Form
Form 2 (Revised) is submitted by the Employee to Nominate the family member or other so that Nominate person can claim the dues of EPF/EPS to survive in absence of the member in case the death. However, EPFO has started the facility for members to fill the Nomination form online on unified member portal.Download Form
Every employee who is required or entitled to become a member of PF and EPS need be asked on the priority by the employer to fill the complete detail in Form 11 (Revised). It will help to generate UAN of the Employee and insert the previous UAN Number in the current Establishment. It is mandatory to keep the filled and signed Form 11 (Revised) in records for future inspection, demand and information.Download Form
PF Form 10 C is submitted by the Employee to withdraw Pension account amount after exit of the service if his service period is above 6 months and below 9.6 years. Employee can also choose the option to obtain Scheme certificate. In which he will be entitle to avail pension on the attending age of 58 years. Employee will needs to provide all Pension scheme certificate for pension. EPFO enabled the facility for EPS members to apply online for Pension Amount Withdrawal if service is more than 6 months and below 9 Years 6 months or obtain Pension Scheme Certificate under Employees' Pension Scheme, 1995.Download Form
PF Form 5 IF is filled by the nominees/family members/legal heirs of the deceased member to claim insurance amount under EDLI benefit after the death of an active PF member. It is sad to inform that the service can be availed only when the member has died while in service. EPFO is bound to release up to Rupees 7 Lakh maximum against the submitted claim as per eligibility and service period.Download Form
In the need of money to survive the life, The Employee can claim advance amount by submitting PF Form 31 and withdraw some part of their PF amount of account as per eligibility or criteria decided by EPFO. The form can be submitted online by the member If the KYC of the member is already seeded online on the unified member portal. Download the file to know the criteria detail decided by the EPFO to withdraw advance in different matter.Download Form
On the death of a member, the nominee/legal heir or the family member of the deceased use the given Form 20 to claim/withdraw the member's Provident Fund amount. However, The form can be submitted online by nominee or legal heir of the deceased person If the KYC of the deceased person and Form-2 (revised) for Nominee declaration was already submitted Online by the deceased person.Download Form
Employee has to submit this Form to transfer/merge the old PF Accounts and its amount and service period to new account. This is required when a member from one establishment left the Establishment and joins another establishment covered under the EPF Scheme. EPFO introduces a new system to facilitate online submission of transfer claims by Members to make transfer process transparent, efficient, smooth and comfortable for you. A member can choose option of attestation of submitted PF Form either through the present employer or the previous one. The employer verify/correct member details and approve or reject the Form approval request online on unified Employer Portal. For online submission of the claims, the digital signature (Class III) of the authorized person is required. In some cases, Employee needs to submit the transfer Claim Form -13 offline.Download Form
Form 19 is submitted by the Employee to settle the PF Account by withdrawing the EPF Amount. The claim is submitted after 2 months of Date of Exit from the Establishment and in condition of unemployed after 2 month or more.Download Form