The Employees' State Insurance Corporation (ESIC) plays a crucial role in providing social security to the workforce. The ESIC 10 form, a key document within this framework, serves a specific purpose. Addressed from the corporation's branch office manager to the employer, it seeks to verify an employee’s abstention from work due to sickness, temporary disability, or maternity. Employers are required to confirm, within 10 days of receipt, the employee's non-attendance at work for the specified period, ensuring they have not received wages as defined under section 2(22) of the ESI Act, 1948. This verification includes any leave, holiday, weekly offs, layoffs, and strikes during the period in question. The response from employers, crucial for processing benefits, includes detailed confirmation regarding wages paid or not paid during absences, including any strikes. This form is instrumental in maintaining the integrity and efficiency of benefit disbursement, ensuring that only eligible claims are processed and upheld. Through this systematic verification process, the ESIC 10 form reinforces the corporation's commitment to providing rightful benefits to insured individuals under its coverage.
| Question | Answer |
|---|---|
| Form Name | ESIC Form 10 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | esic form 10 pdf, esic claim form 10 pdf download, form no 10 esic, esic form 10 pdf download |
w w w . esick ar . gov . in
EM PLOYEES’ STATE I N SU RAN CE CORPORATI ON
REG. FORM - 1 0
CON FI D EN TI AL
ABSTEN TI ON V ERI FI CATI ON I N RESPECT OF SI CKN ESS BEN EFI T/ TEM PORARY D I S ABLEM EN T BEN EFI T / M ATERN I TY BEN EFI T
( Re gu la t ion 5 2 - A)
From :
Th e Man ager
__________________ Br anch Office,
E. S. I . Cor por at ion,
__________________
To :
M/ s _____________________________
________________________________
________________________________
Su bj e ct : V e r ifica t ion of a bst e n t ion fr om w or k in r e spe ct of Sh r i/ Sm t . / Ku m _ _ _ _ _ _ _ _ _ _ _ _ _
I n s. N o . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D e pa r t m e n t _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Dear Sir ( s)
The abov e nam ed em ploy ee of y our fact or y has subm it t ed a cer t ifica t e of in capacit y for t h e per iod fr om ______________________ t o _______________________ and has declar ed t hat he/ she
has not w or k ed on any day dur ing t he abov e per iod .
He/ she has fur t her declar ed t hat he/ she has not r eceiv ed w ages as defined under sect ion
2( 22) of ESI Act , 1948 for any leav e/ holiday / w eek ly off/ lay off and st r ik e in r espect of any day dur ing t h e abov e per iod an d t h at h e/ sh e w as n ot on st r ik e on an y day du r in g t h e abov e per iod .
I shall be gr at eful if y ou confir m t he ex act posit ion, in t his r egar d, on t he for m , appended w it hin 10 day s of t he r eceipt of t his for m .
Your s fait hfully ,
( Manager )
_______________ Br anch Office
w w w . esick ar . gov . in
EM PLOYEES’ STATE I N SU RAN CE CORPORATI ON
CON FI D EN TI AL
REPLY TO BE FU RN I SH ED BY TH E EM PLOYER
I N RESPECT OF FORM N O . 1 0
Nam e of t he I nsur ed Per son/ I nsur ed Wom an _____________________________________________
I nsur ance No. _________________________
Re t ur ned w it h t he r em ar k s t hat t he em ploy ee in quest ion has not w or k ed on any day dur ing t he per iod fr om __________________ t o _____________________ or * t hat he/ she has w or k ed on
__________________ __ dur ing t he per iod fr om __________________ t o ____________________
|
I t is fur t her confir m ed t hat – |
( a) |
He / she r em ained on leav e w it h w ages for t he per iod fr om _ _ _ _ _ _ _ _ _ _ _ _ _ _ t o _ _ _ _ _ _ _ _ _ _ _ |
( b) |
He/ she r em ained on holiday s w it h w ages fr om _____________________ t o _____________ |
( c) |
He / she w as on w eek ly off w it h w ages for _______________________ t o ________________ |
( d) |
He / sh e w as on lay- off w it h w ages fr om ______________________ t o __________________ |
( e) |
He / she w as on st r ik e fr om ____________________________ t o _________ _____________ |
2 . I n case, t he I P/ I W is paid any w ages for any of t he day s falling dur ing t he abov e m ent ioned per iod subsequent ly , t he sam e w ill be not ified t o y ou in due cour se.
3 . The day pr oceeding t he fir st day of absence w as* / w as not a holiday for t he I nsur ed Per son/ I nsur ed Wom en .
D a t e : _ _ _ _ _ _ _ _ _ _ _ _ |
Signa t u r e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ |
|
N a m e in block le t t e r & D e sign a t ion _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
|
Cod e N o . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ |
* St r ik e out if not applicable