Toll-Free Number: 1800-425-0636 | Mail: rd-karnataka@esic.in | esicbng@nic.in



Forms for Employer

Form-01 - Employers' Registration Form

Form - 01A - Annual information of factory/estt submission form

Form 3 - Return of Declaration forms

Form 5 - Return of contributions

Form 5a - Statement of advance payment of contributions

Form 6 - Register of employees

Form 10 - Abstention verification

Form 11 - Accident Register

challan form - Challan Form

Forms for Employees

Form 1 - Declaration Form

Form 2 - Addition / Deletion in Family declaration form

Form 9 - Claim form for sickness /TDB/ Maternity

Form 14 - Claim form for Permanent disablement benefit (PDB)

Form 15 - Claim form for Dependant Benefit (DB)

Form 16 - Claim form for periodical payments of DB

Form 19 - Claim for Maternity benefit

Form 20 - Claim form for Maternity benefit after death of child

Form 22 - Claim form for Funeral Expenses

Form 23 - Life certificate

Form 24 - Dependant benefits declaration