Registration

A Declaration Form in respect of every employee should be submitted to the Branch Office to which he is attached within 10 days from the day on which the relevant information required for filling in the form is made available by the employee. In Delhi, Declaration Form may be uploaded online through Employer’s Login.

This Declaration Form in Form 1 should be accompanied by a return of declaration form in form 3 in duplicate. Normally a declaration form is submitted to a Branch Office only after the allotment of a code number to the factory/establishment.
In respect of female employees separate declaration forms and separate return of declaration forms have to be used and declaration forms and returns should be stamped ‘Female’.

Some of the important points to be born in mind while filling in the declaration form can be summed up as under:
column against the insurance number is to be left blank

If the area is under panel system leave the column against the dispensary blank

If father’s name is not available write the name of mother. A married female employee would indicate the name of her husband only.

Indicate the date of birth correctly.

Full and exact residential address should be indicated

Another important column is the one regarding the nominee. Section 71 of the ESI Act which is relevant in this case reads as follows:

” If a person dies during any period for which he is entitled to a cash benefit under this Act, the amount of such benefit up to and including the day of his death shall be paid to any person nominated by the deceased person in writing in such form as may be specified in the regulations or, if there is no such nomination, to the heir or legal representative of the deceased person.”
The details of the family should be filled in correctly in the relevant column and due care may be taken to fill in only such names which qualify for the status according to Section 2(11) of the ESI Act.
The name of the Branch Office will be that to which the factory/establishment is attached

The signature/thumb impression of the employee should be invariably be given on the D.F. It may be ensured that when an employee is capable to sign his signature may be obtained and not the thumb impression.
The D.F. should be signed by a clerk and should be countersigned by an officer authorised to sign
The full name, code number and address of the factory/establishment should be indicated in the declaration form