Are you an employer looking for information on how to file Form 10 with the Esic? This article explains what is required to submit this form, and provides links to helpful resources. Esic Form 10 is used by employers to report wages paid and contributions made for their employees. Filing this form on time helps ensure that employees receive the proper benefits from the Esic. If you have any questions about completing this form, or need help filing it, be sure to contact an Esic representative.
| 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 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ |
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N a m e in block le t t e r & D e sign a t ion _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
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Cod e N o . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ |
* St r ik e out if not applicable