Employee State Insurance Corporation Application Form

Fill in the below form to apply for ESI registration online. It will take less than 2 mins. Your details are secured by SSL.
Choose your entity*
- Factory
- Shop/Establishment
Name of Establishment/Factory*
Address of Establishment/Factory*
State*
Pin Code*
Premises of Establishment/Factory*
- Owned
- Hired/Rented
- Leased

Total no. of employees*
Please enter a number from 1 to 150.
Male employees*
Mention the total number of male employees.
Please enter a number from 0 to 150.
Female employees*
Mention the total number of female employees.
Please enter a number from 0 to 150.
Number of employees with salary less than Rs.15,000*
Please enter a number from 0 to 150.
No. of male employees with salary less than Rs. 15000*
Please enter a number from 0 to 150.
No. of female employees with salary less than Rs. 15000*
Please enter a number from 0 to 150.

ESI Application Form