| Form No. |
Subject |
To be used by |
| ESIC-32 |
 Wage/Contributory
record for disablement benefit |
Employer |
| ESIC-37 |
Certificate
of re-employment/continuous employment |
Employer |
| ESIC-53 |
Application
for change in particulars of Insured Persons regarding
change of Branch Office/Dispensary |
IP/Beneficiary |
| ESIC-63 |
Declaration
form regarding payment to the legal heir/representative
of the deceased IP |
IP/Beneficiary |
| ESIC-71 |
Particulars of contribution in case Return
of Contribution in respect of an IP not sent |
Employer |
| ESIC-72 |
Application for duplicate Identity Card |
IP/Beneficiary |
| ESIC-86 |
Certificate of
Employment |
Employer |
| ESIC-105 |
Certificate of Entitlement |
Employer |
| ESIC-126 |
Certificate of continuous employment for
Extended Medical and Sickness Benefit |
Employer |
| ESIC-142 |
Claim for conveyance allowance and/or
compensation for loss of wages for an IP appeared before
the medical board |
IP/Beneficiary |
