WHAT IS ESIC ELIGIBILITY FORM?

Posted on 07th Aug 2018 | 1561 views

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ESI eligibility form

ESI eligibility from is also known as the certificate of entitlement and its form number is 105, this form is used when an employee is working in a location where the employee registered ESI dispensary are not available this form is used for the purpose to take authorized leave or temporary duty leave for their treatment to new ESI requested dispensary .ESIC eligibility form or certificate of entitlement should be submitted by the employer to ESIC new dispensary, on ESI form 105 the employer should mention organisation name and employer code and also should mention that employee is on authorized leave or not, and also the exact date on which employee is on temporary duty or authorized duty leave, employer should mention the identification marks of employee in the form along with eligibility form the employer should submit form 10 and this form should be filled by the employee , form 10 is also known as the application for the medical treatment as the temper resident.

ESI eligibility form

ESI eligibility certificate

Certificate of entitlement or ESI eligibility certificate or form contains flowing details

● Name of the employer

● Employer code

● Employee name

● Family members name husband/father name

● Insurance no

● Identification marks of an employee

● Signature/thumb impression

● authorized leave dates

APPLICATION FOR MEDICAL TREATMENT AS TEMPORARY RESIDENT

This is to be filled by the employee it contains following details

● Employee name

● Husband/father name

● Company name

● Authorised leave details

● Dispensary name

● Signature of doctor

● Doctor name

● Signature /thumb impression of the employee

● Code number and stamp of the dispensary

ESI eligibility form

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