How to Download and Fill ESIC Form 105
ESIC form 105 is a certificate of entitlement that has to be filled by the employer when their employees work in another location where their registered ESIC dispensary is not available. This form is used when employees are on temporary duty or authorized leave and need to avail medical benefits from a different ESIC dispensary.
esic form 105 pdf download
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In this article, we will explain how to download and fill ESIC form 105 in simple steps.
How to Download ESIC Form 105
ESIC form 105 can be downloaded from the official website of Employees' State Insurance Corporation (ESIC) at https://www.esic.gov.in/downloadableforms/ESIC-105%20Certificate%20of%20Entitlement.pdf. Alternatively, you can also download it from other websites that provide sample filled forms, such as https://www.hrcabin.com/sample-filled-esic-form-105/ or https://www.scribd.com/doc/22889793/ESIC-105-Certificate-of-Entitlement.
How to Fill ESIC Form 105
ESIC form 105 has two parts: Part A and Part B. Part A has to be filled by the employer and Part B has to be filled by the employee.
Part A requires the following details:
The name and address of the establishment.
The ESIC code number of the establishment.
The name and address of the employee.
The insurance number of the employee.
The reason for issuing the certificate, whether the employee is on temporary duty or authorized leave.
The period for which the certificate is valid, from date to date.
The identification marks of the employee.
The signature and seal of the employer or authorized officer.
Part B requires the following details:
The name and address of the new ESIC dispensary where the employee wants to avail medical benefits.
The signature of the employee.
After filling both parts, the employee has to submit ESIC form 105 along with ESIC med form 10 to the new ESIC dispensary. ESIC med form 10 is a certificate of sickness that has to be filled by the employee and certified by a medical practitioner. This form can also be downloaded from the ESIC website or other sources.
Conclusion
ESIC form 105 is an important document that enables employees to get medical benefits from a different ESIC dispensary when they are on temporary duty or authorized leave. It has to be filled by both the employer and the employee and submitted along with ESIC med form 10. By following these simple steps, you can easily download and fill ESIC form 105 without any hassle.
Benefits of ESIC Form 105
ESIC form 105 has several benefits for both the employer and the employee. Some of them are:
It ensures that the employee does not lose their medical benefits when they are away from their registered ESIC dispensary.
It saves the employee from paying out-of-pocket expenses for medical treatment in a different location.
It reduces the administrative burden on the employer as they do not have to arrange for medical facilities for their employees in a different location.
It helps the employer to comply with the ESIC rules and regulations and avoid any penalties or legal issues.
Frequently Asked Questions about ESIC Form 105
Here are some common questions and answers about ESIC form 105 that you may find useful:
How long is ESIC form 105 valid for?ESIC form 105 is valid for the period specified by the employer in Part A of the form. It can be extended if the employer issues a fresh certificate with a new validity period.
Can I use ESIC form 105 for my family members?Yes, you can use ESIC form 105 for your family members who are covered under your ESIC scheme. You have to mention their names and insurance numbers in Part B of the form and submit it along with their ESIC med form 10.
What if I lose or damage my ESIC form 105?If you lose or damage your ESIC form 105, you have to request your employer to issue a duplicate certificate with the same details and validity period. You have to submit the duplicate certificate along with a declaration stating that you have lost or damaged the original one.
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