How To Fill ESIC Maternity Claim Form 19 | Sample Filled ESIC Claim Form 19

ESIC maternity claim form 19 is also known as the claim for maternity and notice of work.  ESIC claim form 19 has to be submitted to the employer by the insured pregnant woman in order to claim payment of maternity benefits. Under Employee State Insurance Corporation regulations 88, 89 and 91 ESIC form 19 is required to claim maternity benefits of employees. Here you can find complete details on how to fill ESIC maternity claim form 19 and you can also find sample filled ESIC claim form 19.

How To Fill ESIC Maternity Claim Form 19 | Sample Filled ESIC Claim Form 19

↓ Download ESIC Claim Form 19

ESIC self-declaration form related to maternity

ESIC Maternity Claim Form 19

You may also like: ESIC self-declaration form related to maternity

Why Should Insured Woman Submit ESIC Claim Form 19?

As we all know as per maternity benefits act 1961 every insured woman will get 26 weeks of maternity leaves during pregnancy time earlier it was only 12 weeks i.e employer needs to pay salary to the insured woman in these days. Along with this ESIC maternity claim form 19, the insured woman needs to submit ESIC self-declaration form related to maternity.

Note:  On ESIC claim form 19 insured woman need to mention the exact date from which date to which date she is availing maternity leaves.

ESIC maternity claim form consists details like name of the insured woman, ESIC IP number, the address of the pregnant woman, working department of the insured woman and present employer name.

The insured woman is not eligible to claim any leave encashment while availing maternity benefits. Any false representation of ESIC claim form leads to a fine of 2000 Rs.

18 thoughts on “How To Fill ESIC Maternity Claim Form 19 | Sample Filled ESIC Claim Form 19”

  1. hi,
    I have completed my maternity leaves for six months, still not getting e pehchan card for applying this benefits, pls suggest how claim and when i get my maternity salary.

    Thank You.

  2. Respected Sir,
    I Want to know that it is mandatory to do delivery of baby in esic hospital for claim of maternity benefit (Paid Leave).

  3. Hi,
    I took leave for Meternety but till now I didn’t apply for ESI bcoz I don’t know ,my HR didn’t tell me the procedure .Now she told me to apply ESI for salary. Already 3months over. Is it possible to apply to ESI for Meternety leave? Can I get the meternety benifit & how to follow the procedure

  4. Hi Rajesh,
    My wife’s employer told her that ESIC will pay her salary for six months and we need to contact ESIC after her six month’s leave period is over. Can you please guide what documents (Apart from form 19 and Self declaration) we need to submit to ESIC to get her six month’s salary once she report back to office.

    Please assist.

    • Hi Sneh Modi,
      It is better to contact ESIC office before availing maternity leaves and submit ESIC claim form 19 & ESIC self-declaration of the insured woman with proper medical records which you have now.

    • Hi Sangeeta Daksh,
      If they are already getting maternity benefits i.e wages during maternity leave then they can’t able to get ESIC benefits.


Leave a Comment