That means you are a contractor and you have deployed one of your employees on the site of an employer (Principal employer), and you need to inform him that ESI and EPF are not applicable to that employee, right?
Declaration for Non-Applicability of ESI and EPF
There is no legal format for that declaration. You can simply declare that the employee in question is receiving a salary above the threshold limit prescribed under the ESI Act and EPF & MP Act, and therefore, he is not covered under these Acts.
The principal employer will be satisfied with the explanation regarding ESI if the employee's salary is above Rs 21,000. However, he may inquire further about PF deductions because PF is compulsory for employees whose salary at the time of joining is not more than Rs 15,000, specifically the basic salary component. Furthermore, an existing PF member cannot be excluded from PF if his salary exceeds Rs 15,000 at the time of joining your establishment.