notifications esi reg amendment 1 may 2011

8/2/2019 Notifications ESI Reg Amendment 1 May 2011

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3W6 THE GAZETTE OF INDJ -, APRIL 30, 2011 (VAISAKHA 10, J ; ;3)

======PARTm-SEC. 4

New Del.i, the 30th March 2011

No. N-·, J13j2j2010-P&D: Whereas cert.» draft regulations further to .smend the Employees'

State Ii', .urance (General) Regulations, 1)50, were published as requlre.; under sub-section (1)

of section 97 of the Employees' State Insurance Act, 1948 (34 of 1948), in the Gazette of India,

Part Ill, Section 4, dated the 26th February, 2011 for inviting objections and suggestions from

all persons likely to be affected thereby till the expiry of the period of thirty days from the date

on which the copies of the Gazette of India in which the said notification was published, were

made available to the public;

And whereas, the copies of the sad Gazette were made available to the public on the

26th

February, 2011;

And whereas no objection or suggestion has been received from any person in this

regard;

. ,Now, therefore, in exercise of the powers conferred by section 97 of the Employees'

State Insurance Act, 1948, the Employees' State Insurance Corporation, hereby makes the .

following regulations further to amend the Employees' State Insurance (General) Regulations,

1950, namely: -

1) These Regulations may be called the Employees' State Insurance (General)

(Amendment) Regulations, 2011.

2) They shall come into force from 1st May, 2011.

3) In the Employees' State Insurance (General) Regulations, 1950;



I',,, i iJ ')lx.4J THE GAZETTE OF INDIA, APRIL 30, 2011 (VAISAKHA 10,1933)

======3 C E 7

factory/establishment to which tnis Act applies and to whom a code number has already

been allotted, shall intimate to the appropriate Regional Office, Sub-Regional Office,

Divisional Office or Branch Office, any change in the particulars furnished in Form 01 at

the time of registration of the factory/establishment within two weeks of such change."

2. The existing form-01 shall be substituted with the following form.-

"FORM-01

1. Name of the Unit (Factory / Establishment):

i::~~-add-ress along with Pin Code I 1- 1 J_u_r-,is_d_ict_io_n_a_l_

No., Municipality Ward No. (if in a I Phone Nos./Mobile No 'I

' Rev. Village, Name of the Village, & e-mail addressPolice Station

Hobf and all other details of I' Fax No '

L demarcation) I ---------~-------~---------2. Exact nature of activity

(work / business carried on)

3. Date of commencement of the Unit:

4. a) Whether the i ) building/premises of the unit

are hired / owned/ leased.

ii) Machinery & Fixtures of the

unit are hired / owned/ leased.

b) Date of purchase / lease



THE GAZETT: OF INDIA,APRIL 30,2011 (Vt\lSA},.; lA 10, 1933)

================ =================[ P A R T Ill-SEC. 4

Names &

Designations

Permane;"-;: AddressI.elephone Nos.

Iincluding mobile

numbers & e-mail

i address

_L

Names & addresses of the preser.:

Principal employers

.e., Proprietor/Partners/ Managjnf~ I

.xecutive Directors / Chairman/ Lcretarv and the manager of the U .)

'---

9. Addresses of Registered offices/Head Office/ Branch Office/Sales.Offices/Administrative offices and

No. of employees employed therei=

Full Addresses No,of employees employed Tel. Nos.

10. Total No. of persons emploved and No. of

Employees whose wages does not exceed

Rs.15000/- P.M.

i)

ii)

iii)

By Principal employer

Through Immediate Employer (Without ESICode No)

Through Immediate Employer (Having ESICode No)

As on ...•.............. . .

Signature of the Principal Employer.(along with date)·

DECLARATION

I have read the instructions and hereby declare that all the particulars given above are true

and correct to the best of my knowledge and belief. In case of any change at any time In the

information given above, I undertake to intimate those Changes, to the RO/SRO/Branch OffIce within

15days.



J'/l1(T lil--SEC 4} THi: GAZeTTE OF INDIA , A .PRIL 30, 2011 (VAISAKHA 10, 19~3)--------------------

I. The address of the location of work, administration office, Branch Office, Sales

Office etc.

b. The change of management i i K E - Proprietorship to Partnershio etc.

Any change in the existing incumbents along with list ~.,fnew incumbents anr:

their pe rmanen t nddresses cl od phone numbers.

,. Transfer of the unit bv sale/p,ift/lease en.., along with t"p cQ:;ie~of connect.;

documents.

c. ,11,ny change in/ addition to the existing activities, closure of / crt:atlol~ (if O( ".'

Sales offices/ Broach office etc.

2. In case of permanent closure, the sa/ne shall be duly intimated along with copies o r thi'

connected documents to the Regional Office and the concerned Branch office immediately an«

the returns sh all be submitted in accordance with Regulation 26 (b) ot ESI(General) Regulations

1950."

3. The existing form-1 shall be substituted with the foilowing form.·

IJF ORM -1

DECLARATION FORM

(To be submitted in respect of employee who is not already registered under ES!Act~

1 .

:----~'i~ME-oF-TnEEMPLOYEE ----- --r-DATE OF BJRTIDAG): -!-'svi--! -~iARlTA{--I i I I STATUSj (IN BLOCK LETTERS): ! i



3100 THE GAZETTE OF IND' '"APRIL 30, 2011 (VAISAKHA 10,'33)

==== ==============[P ART III--SEc. 4

3, Fa1:herIHusband's Name : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4 . D·:~ of appointment ESIDispensar

LChosen for Tr .tment -------'l ],---5, N'::ne & Address ofthe Employer

&ne Branch Office to which attact-d (Affix the Seal) :

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . , .

.... , ~~ ~ ~ ~ .

. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6, Details of the Nominee for payment of Cash Benefits after death:

Relatlo-n-s-h-ip-&-a-ge-o-r-th-e-- ----P~-rm-a-ne-n-t-A-d-d-res-s--~I

nominee ,I

- - ' - - 1

I

. I

~ ~I ~ J

Name

~------------+--------!.----------+--- ....-_.-.._--_._._-_.

7, Family Particulars:

11 SI,No. I Name & RelatioDship with

th I.P

If Residing elsewhere.

Add I ith

Date of Birth

&Ag

Wbetber

R 'd' ith, I eason esi lng Wl I ress a ong WlI

I

IName .flhe Slate Idate the I.P,

I:j



,)'(i ill SI-(.4J H1E GAZETTE OF INDIA, APRiL 30, 20]] (VAISAKHA 10,1933)-.~~:=.:~-::::.::::==-----.--.----------. - -

31\

9. In case of person with disability, please specify the nature of Disability and its percentage

(Please enclose relevant documents).

DECLARATION

1 I undertake to intimate any change in the membership of my family within 15 days of such

change.

2. I hereby certify that particulars furnished above are true to the best of my knowledge.

Signature of the l. P .

Countersignature of Principal Employer

Or Authorised Signatory (along with Name & Date) .1

4. The existing form-12 shall be substituted with the following form.-

"Form-12

ACC IDENT REP ORT FRO M EMP LOYER UNDER REGULAT ION 68

D AT E O F A CC ID EN T:

1. NAME , IN SURANCE NO . OF IN JURED P ERSON



-3102 THE AZETTE OF INDIA, APRIL 30,2011 :\.lSAKHA 10, 1933) [ P . - . & T I-SEC, 4

====== ==============

8) iF ACC ID ENT OCC l, 'RED OUTSID E TH E P REM ISE S OF T, FACTORY OR ESTABLISHMENT

A) EXACT ssor 0 HE ACCIDENT

B ) W HE RE HE VIlli. "RAVEttlNG TO AT TH A7 liME

C } THE D ETAILS or THE VE HIC LE HE W AS TR AVELLIN G. [THE TIM E O F ACC ID EN T,

R EGISTR AIO N N O., M AKE, W HETHE R IT IS HIS OWt:,.':TC)

D) WHETHER HE WAS ON OFFIC IAL DUTY OR COM ING ro WORK PLACE OR

R ETU RN IN G HOME

E) IS FIR LODGED AND ANY POSTM ORTEM CONDU CTP'

D ATE O F ACC ID EN T R EPO RT N Ji./:;iE , C OD E NO . AND ADDRESS

O F TH E fA CTORY lE ST ABLlSHMENT(SE AL)

SIGN ATU RE O F THE E MPLO YE R IAUTHOR ISED S !GNATORY "

. .

(B.K.SAHU)

Insurance Commissioner.

notifications esi reg amendment 1 may 2011

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