Respected Seniors I have submitted form 12 of ESIC office, now ESIC office is asking for the Eligibility Form from Employer Side. Sir, Pls guide me what is it & how i can get the same?
From India, Gurgaon

form 12 is accident report and has to be submitted by employer ONLINE

pls let us know it is compulsory Thanks & Best Regards Gangadhar
From India , Bangalore

accident report is to be filed by employer online at portal, and copy should be provided to panel doctor / dispensary, with signature and seal. ask your employer to submit it online

Seniors Pls Guide over the Eligibility Form. what it is & how we can get the same? Aside Gangadhar :: Accidental report (Form 12) is mandatory to be filled by employer to avail the benefits
From India, Gurgaon

if any accident happens during the duty hours then employer has to make entry of the accident in "accident book of ESIC" two witness sign the incident,
in case of duty off hours employer is not bound to issue form 12, as the incident is not happened in duty hours or his premises, neither of his employees may witness the same.
employer then submit the brief summary of accident , which is noted in accident book, vide form 12 online to ESIC within 48 hrs, and provide a signed copy to the employee or his relative, for onward submission to ESIC dispensary or panel doctor, where the IP is getting treatment
you can get the form from ESIC website here

1. Sir, now Online procedure has been introduced in ESIC and I am not sure about the exact form which may be called as Eligibility Form. However, I have observed that earlier there was FORM ESIC 37, which was used by employers to certify the eligibility of the employees and was required to be submitted to Branch Office, ESIC so that said employee may claim benefit from said Office.
2. I think, if it is the same form ESIC-37 it may be available in printed form in Branch Office of ESIC and you can obtain the same from said office and submit the same to appropriate branch office of ESIC so that employee may obtain benefit. However, online link regarding one form called ESIC MED-37 is mentioned as follows. I think, it is the same form and you can confirm the same from your appropriate ESIC Branch Office Manager.

From India, Noida

form 37 is not in use,
TIC or e pahchan is used now, seeded with aadhaar card,
go to portal, edit employee details, >personal details, enter aadhaar no, , save
go to print employee card, TIC will be visible, get it print, , on the top of it, medical acceptance card link is also available
TIC would be signed in duplicate one for employee and another for his family, medical acceptance card just print and hand over, , it would be submitted to panel doctor or ESIC dispensary for enrollment
there is nothing in ESIC like eligibility form or card

Hi, The question you are asking about is "eligibility form"...! But the answers you got are irrelevant.
The eligibility form is required in case if you are approaching to a dispensary which is not actually your dispensary.
Suppose your dispensary is at one location/city (Ex:HYD), but your dependents dispensary is at another location/city(Ex:Pune), if your dependent also visited the same dispensary which is HYD, in this case you are asked to submit the eligibility form.The same form is asked to you, if you also visit other dispensary (Ex:Pune)
You can download this form at below link

From India, Hyderabad
Dear Friends,
Our learned friend Danush right in answering on eligibility certificate. I will give some addition to him.
This certificate is asked by dispensary or hospital when you i.e. IP approach it for any special treatment / operation etc. This certificate is issued by Branch Office.
This certificate is now available on ESI portal to IP. But the dispensary / hospital they do not accept it unless the same is not signed & stamped by Branch Office.

From India, Mumbai

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