ESIC Form Back
ESIC Form Back
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'iFamily means all or any of the following relatives of an insured Person namely :dependant on the til u sfiorse (ii) a minor iegitimate or adopted child depe_ndant upon the 1.P., (iii) a child who is whollyunmarried daughter; l.p. and w6o is (a) receiving education, till he or she attains the age of 21 years (b) an i,i*oigu of tn6 who is infirm by reason of any physical or m.ental abnormality or injury and is wholly dependant on the earnings t,ul r l.p. if in* "iifOso long as the infirmity continues, iv) dependantparents (Plelse see Section 2 clause 11 of the E S I Act 1948 for details)
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Submission of false information attracts penal action under section 84 of ESI Act, 1948.
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This Form duly filled in must reach the concerned Branch Office within 10 days of appointment of an Employee. Delay attracts penal action under seclion 85 of the Act, aganist employer.
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od?lt d frq) | ,,:__, --_^ ._^_ {^r-. . iL_^ts r. As un insu',eJ derson you and your dependant family members are entitled to full medical care from today itself. Thb other Disablement benefit (3) Permanent disablement Benefit (4)Debenefits in case includ-e {1) Sickness Ejenefit (2) Temporary pendents benefit and (5)'Maternity Benefit (in case of women employees)'subject to fulfillment of cantributory conditions.
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For more details qT ytrctT oTqf-dq qr elhq l3qd Aqqrf,cwww.esic.org.inol cbntact website of ESIC at www.esic.org.in or contact Regional office or Branch Office.
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