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Download Declaration form (PDF Format)  

 

 

To All Employers / Employees

Dear Employer / Employee,


                 ESI Corporation has embarked on an ambitious e-governnance project “Project Panchdeep” involving computerization / automation of all ESI Institutions across the country.  All the ESI Hospitals, Dispensaries, (both ESIC and State-run), and all the Offices of the ESIC and State ESI Directorates are being networked for this purpose.  M/s.Wipro Technologies, one of the  major Indian IT Companies, is executing this project for ESIC.


                 On implementation of the project, the following significant solutions will be available for employers as well as employees, among others:-


1

 Better delivery of services at ESI Branch Offices, Regional Offices, Hospitals and Dispensaries

2

Services anywhere at any ESI Institution

3

Online registration of employers and employees

4

Online payment of contributions etc.,

5

Hospital Management System

6

Dispensary Management System

 

Among the above solutions, the key solution would be better delivery of services and service anywhere at any ESI institution available to the employees / insured persons.  With a view to achieve this, the ESIC is introducing “Smart Card”, in place of the existing conventional paper card, to the beneficiaries under the ESI Scheme.  (Smart Card has already been formally launched in Karnataka (Bangalore).


                Since issue of Smart Card would require creation of an updated database of insured persons and their eligible family members as on date, the ESIC has planned to obtain fresh declaration forms from all employees under the ESI Scheme through their respective employers, in a prescribed format.  Fresh data obtained will be processed in due course.  After this exercise, the insured persons along with eligible family members on roll will be required to attend camps to be organized by ESIC at convenient locations for necessary photographing and capturing of bio-metric details of the beneficiaries.  Ultimately, “Smart Cards” will be delivered to the insured persons at their doorsteps.  Two Smart Cards will be issued, one to the insured person and the other to the family residing away. 


                Needless to say, this Smart Card will be handy and useful, as an insured person or his family with this card in possession can avail any service (including medical treatment) at any ESI institution at his will.


                 All said and done, your obligation / assistance as the employee / employer, in the special task of giving / obtaining fresh declaration form in complete shape with your signature / countersignature, and reaching them to us at the respective Branch Office of ESIC, cannot be undermined.  We strongly advise that each employer / employee be involved in this preliminary exercise, so that smart card may not be delayed or denied to any insured person at a later stage.


                  Herewith, we enclose a specimen declaration form (in standard A4 size).  We recommend that sufficient number of copies of this declaration form may be made at your end for use as per requirement. We also enclose a step-by-step guidelines to be followed for giving / obtaining this special declaration form and sending them to the appropriate Branch office of ESIC.  Submission of data in electronic form is also encouraged.                                                                          
                 Success and effectiveness of the above exercise will depend much on the sincere co-operation and timely support of both Insured Persons and the Employers, who we believe would rise to the occasion and be with us at this important juncture.  Of course, we will be reverting back to you later when we start organizing Smart Card Camps for photographing, etc. 


 Encl :    1. Specimen declaration form                                                                              
                2. Guidelines

 


Rattan Kumar
Joint Director (I/C), for ESI Corporation

 

 

 

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