Exploring Various Types of ESIC Claim Form

In the realm of employee benefits and social security, the Employees’ State Insurance Corporation (ESIC) plays a pivotal role in India. With a mission to provide comprehensive social security to workers, ESIC offers a range of benefits to employees in times of need. As a trusted source of information, we delve into the different types of ESIC Claim Form, elucidating their purposes and procedures.

Types of ESIC Claim Form

1. Form 22: Funeral Expenses Claim

Form Description: Form 22 is utilized for claiming funeral expenses of an insured person covered under the ESIC scheme. It aids in reimbursing the costs incurred by the nominee or family members for the last rites.


  1. The nominee or family member needs to duly fill Form 22.
  2. Attach a copy of the death certificate, along with the hospital’s or medical practitioner’s certificate.
  3. Submit the form to the designated ESIC branch office.
  4. The claim is then processed, and the reimbursement is disbursed.

2. Form 23: Life Certificate

Form Description: ESIC Form 23 serves the purpose of a life certificate. It ensures that pensioners and their dependents continue receiving the pension and benefits they are entitled to under the scheme.


  1. The pensioner or beneficiary must complete Form 23.
  2. Submit the form to the local ESIC office, along with necessary documents, such as a photograph and the pensioner’s signature.
  3. The ESIC authorities verify the details and issue the life certificate, allowing the continuation of benefits.

3. Form 19: Claim for Maternity Benefit

Form Description: Form 19 is designed for female employees who are eligible for maternity benefits. It facilitates the claim process for financial support during their maternity leave.


  1. The pregnant employee fills out Form 19.
  2. Attach a medical certificate confirming the pregnancy and expected delivery date.
  3. Submit the form to the employer, who further forwards it to the ESIC office.
  4. After verification, ESIC approves the claim, and the benefit amount is disbursed.

4. Form 12: Accident Report Form

Form Description: Form 12 serves as an accident report form under the ESIC scheme. It helps in documenting accidents that occur within the workplace premises.


  1. The employer or supervisor needs to complete Form 12 in case of a workplace accident.
  2. Provide details of the accident, the injured employee, and witnesses, if any.
  3. Submit the form to the ESIC office within 24 hours of the incident.
  4. ESIC evaluates the claim and provides necessary benefits to the injured employee.

5. Form 10-D: Claim for Dependent Benefits

Form Description: Form 10-D is used to claim dependent benefits under the ESIC scheme. It allows the dependents of a deceased insured person to receive the benefits they are entitled to.


  1. The nominee or family member should complete Form 10-D.
  2. Attach relevant documents, such as a copy of the death certificate and the nominee’s bank details.
  3. Submit the form to the ESIC office for processing.
  4. Once verified, the dependent benefits are granted to the nominee or family member.
ESIC Claim Form

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In conclusion, understanding the various types of forms for claims under the ESIC scheme is crucial for employees and beneficiaries to avail themselves of the benefits they rightfully deserve. Each form serves a specific purpose, ensuring that employees and their families can receive financial assistance during various life events. By adhering to the prescribed procedures and documentation requirements, individuals can navigate the claim process seamlessly and secure the support they need.

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