ESIC Form CR 1 Download: A Guide for Employees and Employers
Employees' State Insurance Corporation (ESIC) is a statutory body that provides social security benefits to employees working in the organized sector in India. ESIC covers employees against various contingencies such as sickness, maternity, disablement, and death due to employment injury. ESIC also provides medical care to insured employees and their families.
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One of the benefits that ESIC offers is the relief under the ESIC COVID-19 Relief Scheme, which is applicable to employees who have died due to COVID-19 or have been discharged from service on account of disability or invalidation caused by COVID-19. To avail this benefit, employees or their dependents need to fill and submit the ESIC Form CR 1, which is also known as the Claim Form for Relief under ESIC COVID-19 Relief Scheme.
In this article, we will explain what is ESIC Form CR 1, how to download it, how to fill it, how to submit it, and what are the documents required for it. We will also answer some frequently asked questions about ESIC Form CR 1.
What is ESIC Form CR 1?
ESIC Form CR 1 is a declaration form that has to be filled by the insured person or his/her dependents to claim the relief under the ESIC COVID-19 Relief Scheme. The relief amount is based on the average daily wages of the deceased or disabled employee and is payable for a maximum period of two years from the date of death or discharge.
The purpose and benefits of ESIC Form CR 1
The purpose of ESIC Form CR 1 is to provide financial assistance to the employees or their families who have suffered due to COVID-19. The benefits of ESIC Form CR 1 are:
It helps in compensating the loss of income due to death or disability caused by COVID-19.
It helps in meeting the expenses related to medical treatment, funeral, education, etc.
It helps in reducing the financial burden and stress on the affected families.
The eligibility and conditions for ESIC Form CR 1
The eligibility and conditions for ESIC Form CR 1 are:
The employee must have been covered under the ESI scheme at the time of death or discharge.
The employee must have died due to COVID-19 or have been discharged from service on account of disability or invalidation caused by COVID-19.
The employee must have contributed to the ESI fund for at least 78 days in one year immediately preceding the date of death or discharge.
The employee must have been earning less than Rs.21,000 per month as wages.
The dependents of the employee must be eligible as per the ESI Act and rules.
How to download ESIC Form CR 1?
There are two methods to download ESIC Form CR 1: online and offline.
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Online method
The online method to download ESIC Form CR 1 is as follows:
Visit the official website of ESIC at Click on the "Forms" tab on the homepage and select "ESIC COVID-19 Relief Scheme" from the drop-down menu.
A new page will open with the details of the scheme and a link to download ESIC Form CR 1 in PDF format.
Click on the link and save the form on your device.
Offline method
The offline method to download ESIC Form CR 1 is as follows:
Visit the nearest ESIC branch office or dispensary in your area.
Ask for ESIC Form CR 1 from the staff and collect it.
You can also request for a copy of the form by mail or courier by providing your name, address, and contact details.
How to fill ESIC Form CR 1?
ESIC Form CR 1 is divided into two parts: Part A and Part B. Part A has to be filled by the insured person or his/her dependents, and Part B has to be filled by the employer. The form has to be filled in English or Hindi, using capital letters only. The form has to be signed and dated by the applicant and the employer.
Sample filled ESIC Form CR 1
Here is a sample filled ESIC Form CR 1 for your reference:
PART A (To be filled by Insured Person/Dependents)
1. Name of Insured Person
RAMESH KUMAR
2. Insurance Number
1234567890
3. Date of Birth
01/01/1980
4. Date of Death/Discharge from Service
01/06/2023
5. Cause of Death/Discharge from Service
COVID-19
6. Name of Nominee/Dependent(s)
SUNITA KUMAR (Wife)
7. Relationship with Insured Person
Spouse
8. Date of Birth of Nominee/Dependent(s)
01/01/1985
9. Address of Nominee/Dependent(s)
H.NO.123, STREET NO.4, DELHI-110001
10. Bank Account Number of Nominee/Dependent(s)
1234567890123456
11. IFSC Code of Bank Branch
SBI0000123
12. Mobile Number of Nominee/Dependent(s)
9876543210
13. Aadhaar Number of Nominee/Dependent(s)
1234 5678 9012
14. Declaration by Nominee/Dependent(s)
I hereby declare that the above information is true and correct to the best of my knowledge and belief. I also declare that I am the legal heir of the deceased/disabled insured person and I am entitled to receive the relief under the ESIC COVID-19 Relief Scheme.
15. Signature/Thumb Impression of Nominee/Dependent(s)
_______________________
16. Date
01/07/2023
PART B (To be filled by Employer)
1. Name and Address of Employer
M/S ABC PVT LTD, H.NO.456, STREET NO.5, DELHI-110002
2. Code Number of Employer
1234567
3. Date of Joining of Insured Person
01/01/2020
4. Date of Leaving of Insured Person
01/06/2023
5. Average Daily Wages of Insured Person for last 12 months
Rs.500/-
6. Declaration by Employer
I hereby declare that the above information is true and correct to the best of my knowledge and belief. I also declare that the insured person was employed in my establishment and was covered under the ESI scheme at the time of his/her death/discharge.
7. Signature and Seal of Employer
_______________________M/S ABC PVT LTD
8. Date
01/07/2023
How to submit ESIC Form CR 1?
ESIC Form CR 1 can be submitted online or offline, depending on the convenience of the applicant.
Online submission
The online submission of ESIC Form CR 1 is as follows:
Visit the official website of ESIC at .
Login with your username and password, or register if you are a new user.
Go to the "ESIC COVID-19 Relief Scheme" section and click on "Apply Online".
Upload the scanned copy of ESIC Form CR 1 and the required documents in PDF format.
Verify the details and submit the application.
You will receive a confirmation message and a reference number for future reference.
Offline submission
The offline submission of ESIC Form CR 1 is as follows:
Print the filled ESIC Form CR 1 and attach the required documents in original or attested copies.
Visit the nearest ESIC branch office or dispensary in your area.
Submit the form and the documents to the concerned officer and obtain a receipt.
You will be notified about the status of your application by mail or phone.
What are the documents required for ESIC Form CR 1?
The documents required for ESIC Form CR 1 vary depending on whether the applicant is an employee or an employer. Here is a list of the common documents required for both:
For employees
Aadhaar card of the insured person and his/her dependents.
Bank account details of the insured person and his/her dependents.
Death certificate of the insured person, if applicable.
Medical certificate or discharge summary of the insured person, if applicable.
Affidavit or declaration by the dependents, if applicable.
For employers
Aadhaar card of the employer or authorized signatory.
Code number of the employer.
Wage register of the insured person for last 12 months.
Attendance register of the insured person for last 12 months.
Appointment letter or service certificate of the insured person, if applicable.
Conclusion
ESIC Form CR 1 is a vital document for claiming the relief under the ESIC COVID-19 Relief Scheme. It is important to download, fill, and submit it correctly and timely to avail the benefit. The form can be downloaded from the official website of ESIC or obtained from the nearest ESIC branch office or dispensary. The form can be submitted online or offline, along with the required documents. The relief amount will be credited to the bank account of the eligible nominee or dependent within 15 days of verification. For any queries or grievances, one can contact the ESIC helpline number at 1800-11-2526 or email at esicovidrelief@esic.in.
FAQs
What is the relief amount under the ESIC COVID-19 Relief Scheme?The relief amount under the ESIC COVID-19 Relief Scheme is equal to 90% of the average daily wages of the deceased or disabled employee, multiplied by 30 days, payable for a maximum period of two years from the date of death or discharge.
Who can apply for ESIC Form CR 1?ESIC Form CR 1 can be applied by the insured person who has been discharged from service on account of disability or invalidation caused by COVID-19, or his/her dependents who have lost their breadwinner due to COVID-19.
What is the last date to apply for ESIC Form CR 1?The last date to apply for ESIC Form CR 1 is within three months from the date of death or discharge of the insured person. However, in case of delay due to unavoidable circumstances, an extension may be granted by ESIC on sufficient grounds.
How can I check the status of my ESIC Form CR 1 application?You can check the status of your ESIC Form CR 1 application by visiting and entering your reference number and mobile number. You can also call the ESIC helpline number or email the ESIC COVID-19 Relief Scheme team for any assistance.
What if I have any complaint or grievance regarding ESIC Form CR 1?If you have any complaint or grievance regarding ESIC Form CR 1, you can register it online at or visit the nearest ESIC branch office or dispensary and submit a written complaint. You can also contact the ESIC Public Grievance Officer at 011-23234092 or email at pgo@esic.in.
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