Employees’ State Insurance Corporation (ESIC) is a self-financing social security and health insurance scheme for Indian workers. You will come across various ESI Forms for different purposes.
What is ESI Form 1
ESIC Form 1 is a declaration by employee to employer to include the employee under ESI Scheme. This form is also called as ESIC declaration form.
In this post you will learn how to fill ESI Form 1 and you can also find a filled sample on this page.
How to Fill ESI Declaration Form 1
Update: Now you don’t need to fill this form offline. Your employer can fill this form online on ESI Ip Portal. You don’t need to send this filled form ESI but your employer needs all the information to fill online form. So, even after online method is implemented, you have to fill this form and submit to your employer. Your can use this information to fill the online ESIC Employee Registration Form 1.
You can find Online ESIC form 1 at ESI Portal. Your employer need to enter their username and password to register a new employee under ESI Scheme. After login to esic portal, there is a option to register new employee. Once new employee is registered on portal, you will get ESI Corporation Temporary Identity Card (Valid for 3 month from the date of appointment).
Now, lets see how to fill this form.
ESIC Form 1 Filled Sample Download
This form contains 2 parts. Insured persons (Employee) details and employer details. You have write your name, father name, date of birth and present & permanent address. Employers ESI Code Number, Date of appointment, address of the employer.
In case of any previous employment, you have to provide your previous ESI Number, previous Employer’s Code No, Name & Address of the previous Employer.
Once you fill employee and employer’s particulars, you can register nominee details for payment of cash benefit in the event of death. You can provide your father, mother, spouse or any other family member or a specified relative.
After that, employee and employer should sign by declaring that the particulars given by employee are correct to the best of my knowledge and belief.
Family Particulars of Insured person need to be provided to get benefits of ESI scheme to family members. The members of family who are dependent on employee need to be mentioned. You should also intimate ESI about any changes in the membership of family within 15 days of such change.
Then you need to fill ESIC Temporary identification card which will be valid for 3 months from the date of joining in service. Your employer will issue this card by signing on it. After that you will receive permanent id card from ESIC.
Two Postcard Size photographs to be attached with the form.
As an insured employee himself and his/her dependent family members are entitled to full medical care. The other benefits in cash include
- Sickness Benefit
- Temporary Disablement benefit
- Permanent disablement Benefit
- Dependents benefit
- Maternity Benefit (in case of woman employees) subject of fulfillment of contributory conditions.
Family members means all or any of the following relatives of an Insured Employee namely
- a spouse
- a minor legitimate or adopted child dependent upon the Insured person.
- a child who is wholly dependent on the earnings of the employee (a) receiving education, till he or she attains the age of 21 years (b) an unmarried daughter;
- a child who is infirm by reason of any physical or mental abnormality or injury and is wholly dependent on the earnings of the insured person. so long as the infirmity continues;
- dependent parents
Click Here to Download ESIC Form 1 in Word Format
Click Here to Download ESIC Declaration Form 1 in Pdf Format
This is all about ESI Declaration Form 1. Hope you find this post useful in filling ESIC form 1. If you need any help, please comment below. I Can Help!…