INSTRCTIONS
1. Submission of Form-l is govered by regulations 11 & 12 of ESI(Genral) Regulations, 1950.
2."Familly" means all or any of the following relatives of an insured Person namely:-(i) a spouse (ii)a minor legitimate or adopted child/dependant upon the
   I.P.(iii) a child who is wholly dependant on the earnings of the I.P. and who is (a) receiving education, till he or she attains the age of 21 years (b)
   an unmarried daughter,(iv) a child who is infirm by reason or any physical or mental abnormality or injury and is wholly dependant on the earnings of the 
   I.P. so long as the infirmilty continues, (v) dependant parents (Please see sections 2 clause 11 of the ESI Act,1948 for details).
3. identity Card is Non-transferable.
4. Loss of identity Card be reported to Employer/Branch Manager immediately.
5. Submission of false information attracts penal action under Section 84 of ESI Act, 1948.
6. This form duly filed in must reach the concerned Branch Office within 10 days of appintment of an Employee. Delay attracts penal action under Section 85 
   of the Act against employer.
7. As an insured Person you and your dependent family members are entitled to full medical care. The other benefits in case include (1)Sickness Benefit 
  (2)Temporary Disablement Benefit (3) permanent Disablement Benefit (4)Dependant's Benefit and (5)Maternity Benefit(in case of women employees) subject to
   fullfilment of contributory conditions.
8.  For more details, please visit website of ESIC at www.esic.org.in or contact Regional office or Branch office.