India employees state insurance corporation 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the name and address of your factory or establishment in the designated field.
3. Input your Employer’s Code Number and the Local Office information accurately.
4. In the declaration section, confirm that all employees listed meet the criteria outlined in section 2(9) of the Employees’ State Insurance Act, 1948. Ensure you include only those earning up to Rs.7,500 per month.
5. List each employee's details in the provided table, including their Serial No, Name, Distinguishing No (if applicable), and Father’s or Husband’s name.
6. Indicate if any accidents occurred concerning these employees; if none occurred, ensure this is clearly stated.
7. Finally, add your signature as an authorized signatory along with the date and place before submitting the form.

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