Employees' State Insurance Corporation Punjab & Chandigarh
 
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ESIC HOSPITAL CHANDIGARH
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ESIC Information
ESl Hospital Chandigarh
ESl Hospital (Punjab)
Dispensaries
ESIC Properties (Punjab)
Branch offices (Punjab)
Implemented Areas
Medical Boards
Contact Information

Tenders
Photo Gallery
Recruitment/Result
 

 
Download Forms
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 (Revised w.e.f. 01.04.2008)
Form 5a Statement of advance payment of contributions
Form 6 Register of employees
Form 10 Abstention verification
Form 11 Accident Register
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
 
Changes in ESIC forms
Changes will be effective from 1st January, 2005. The revised forms are available for download from this site.
Form 01 Regulation 10-B(a) Form-01 and Form –01-A
Form- 1 Regulation 11 & 12 Form-1
Form- 1-B Regulation 15-B Form-2
Form-6 Regulation –26 Form-5 (Revised w.e.f.01.04.2008)
Form-6 -A Regulation-31 (Second proviso) Form- 5-A
Form-7 Regulation 32(1)(a) Form-6
Form-8,9 & 10 Regulation 57, 58, 59, 89-B Form-7
Form-28 & 28-A Regulation 52-A(1) & (2) Form-10
Form-11 Regulation 61 & 89-B Form-8
Forms – 12, 12-A, 13, 13-A, 14 & 14-A Regulation 63 & 89-B Form-9
Form-15 Regulation 66 Form-11
Form-16 Regulation 68 Form-12
Form-25 Regulation 76-A Form-14
Form-17 Regulation 79 & 95-C Form-13
Form-18 Regulation 80 Form-15
Form-18-A Regulation 83-A Form-16
Form 19 & 20 Regulation 87 Form-17
Form 21 & 23 Regulation 88(i)(iii) & 89 Form-18
Form-22 & 24 Regulation 88(ii), 89 & 91 Form-19
Form-24-A Regulation 89-A Form-20
Form-24-B Regulation 89-A Form-21
Form-25-A Regulation 95-E Form-22
Form-26 Regulation 107 Form-23
Form-27 Regulation 107-A Form-24
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