Sample Filled ESIC Contribution Transfer Form

Introduction

This document is a Sample Filled ESIC Contribution Transfer Form. This form is used to transfer the Employees’ State Insurance Corporation (ESIC) contribution from one employer to another. It is important to fill out this form accurately and completely in order to ensure that the transfer of ESIC contribution is successful. This form should be filled out by both the current and the new employer. The information provided in this form will be used to transfer the ESIC contribution from the current employer to the new employer.

Sample Filled ESIC Contribution Transfer Form

ESIC Contribution Transfer Form

To:
Employees’ State Insurance Corporation

From:
[Name of Employer]
[Address]

Date: ________________

Re: Transfer of ESIC Contributions

I, [Name of Employer], hereby request the transfer of ESIC contributions from my current account to the following account:

Account Number: ________________

Name of Account Holder: ________________

Name of Bank: ________________

Branch: ________________

I understand that the transfer of ESIC contributions will be made on a monthly basis and that I am responsible for ensuring that the contributions are paid in a timely manner.

I hereby certify that the information provided in this form is true and correct.

Signature: ________________

Name: ________________

ESIC contribution transfer form is used to transfer ESIC contribution of an insured person from one ESIC IP number to another ESIC IP number. This form generally required when the same person has two ESI numbers. Generally, this happens when insured person changes his or her job and doesn’t tell their previous ESIC IP number to the new employer then automatically new employer will generate another IP number to the same insured person. Here you can download sample filled ESIC contribution transfer form.

↓ ESIC Contribution Transfer Form Download

But as per Employee State Insurance Corporation rules and regulations, only one IP number will be given to every employee in their life time, the remaining IP numbers which they will get after generation of their first ESI IP number will become duplicate. So it is always important to carry forward ESI IP numbers to their new jobs.

The identification of duplicate IP numbers by ESIC website may take some day to months and only your employer can able to identify duplicate IP numbers in their employer ESI portal. When present IP number of an insured person becomes duplicate then it will appear in green colour and original IP number will appear in brackets in ESIC Portal. When this appears then employer can’t able to make payment to the duplicate IP number. In this case employer has to register original IP number of that person again in their ESI portal and then they can able make payment.

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Now the entire contribution made to the duplicate IP number will become useless until they fill and submit ESIC contribution transfer form. On this from mention Insured person’ s original and duplicate IP numbers and take employer attestation and submit it to ESIC regional office. With in 30 days, your ESIC contribution will transfer from duplicate IP number to original IP number.

↓ ESIC Contribution Transfer Form Download

Sample Filled ESIC Contribution Transfer Form:

Sample Filled ESIC Contribution Transfer Form Page 1

Sample Filled ESIC Contribution Transfer Form

Filled ESIC Contribution Transfer Form Page 2

Sample Filled ESIC Contribution Transfer Form

↓ Download Filled ESIC Contribution Transfer Form

Do share your opinions and doubts on sample filled ESIC contribution transfer form.

Sample Filled ESIC Contribution Transfer Form

Employees’ State Insurance Corporation (ESIC) is a social security organization that provides medical and financial benefits to employees in India. The ESIC Contribution Transfer Form is used to transfer the contribution of an employee from one ESIC account to another. This form is used when an employee changes his/her job and wants to transfer the contribution from the previous employer to the new employer.

Instructions to Fill the ESIC Contribution Transfer Form

  • The form should be filled in English or Hindi.
  • The form should be filled in block letters.
  • The form should be filled in the presence of the employer.
  • The form should be signed by the employer and the employee.
  • The form should be submitted to the ESIC office.

Sample Filled ESIC Contribution Transfer Form

The following is a sample filled ESIC Contribution Transfer Form.

Name of the Employee John Doe
Employee’s ESIC Number ESIC12345
Name of the Previous Employer ABC Company
Previous Employer’s ESIC Number ESIC67890
Name of the New Employer XYZ Company
New Employer’s ESIC Number ESIC09876

I, John Doe, hereby declare that I have changed my job and I want to transfer my ESIC contribution from my previous employer, ABC Company, to my new employer, XYZ Company.

Signature of the Employee: ___________________

Signature of the Employer: ___________________

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