📍 When to use this template
- Monthly ESI contribution + return.
- Worker onboarding (ESI card / IP number).
- Medical claim / cash benefit processing.
- Audit + ESIC inspection.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Registration4 fields
Establishment Code (ESIC)
_____________
Date of Registration
_____________
ESIC Branch + Code
_____________
Authorized Signatory
_____________
2Monthly Contribution7 fields
Month + Year
_____________
Total Workers Eligible (earning < ₹ 21,000)
_____________
Total Wages Subject to ESI
_____________
Worker Contribution @ 0.75 %
_____________
Employer Contribution @ 3.25 %
_____________
Total Remittance (4 % of wages)
_____________
Challan Number + Date
_____________
3Wage Threshold4 fields
Wage Limit (₹ 21,000 per month gross)
_____________
Workers Above Threshold (Not Eligible)
_____________
New Workers Added
_____________
Workers Crossing Threshold
_____________
4Returns + Compliance4 fields
Monthly Return (Form 5) Filed Date
_____________
Half-Yearly Return (Form 6) Filed
_____________
Late Filing Penalty (if any)
_____________
Inspection History
_____________
5Worker Benefits5 fields
IP Number Issued
_____________
Sickness Benefit Claims
_____________
Maternity Benefit (Women > 39 weeks)
_____________
Disability Benefit
_____________
Medical Reimbursements
_____________
💡 Sample filled excerpt
May 2026. Eligible workers: 132 (out of 145, 13 above wage limit). Wages: ₹14.5 lakh. Worker contribution @ 0.75 %: ₹10,875. Employer contribution @ 3.25 %: ₹47,125. Total remittance: ₹58,000. Filed Form 5 by 15-Jun-2026. 5 IP numbers issued. 2 sickness benefit claims processed.
⚖ Compliance notes
- ESI Act applies to establishments employing > 10 workers (some states 20).
- Wage threshold ₹ 21,000/month gross — workers above this not eligible.
- Contribution: Worker 0.75 %, Employer 3.25 % of gross wages (total 4 %).
- Monthly return (Form 5) by 15th of next month; Half-yearly (Form 6) by 28th.
- Workers receive: medical care + sickness benefit + maternity benefit + disablement benefit + dependent benefit.
- ESI dispensary at site OR tie-up with ESI hospital — coordinate at mobilization.