Sample Filled ESIC Form 53 | How To Fill ESIC Form 53

ESIC form 53 is also known as the application for change in particulars of insured person. These particulars are like ESIC dispensary, employee name, employee father’s name, DOB, and address. ESI form 53 has to be submitted to the respective medical officer of ESIC corporation and at the same time,  ESIC form 53 needs both employee and employer signatures. Here you can find sample filled ESIC form 53 and instructions on how to fill ESIC form 53.

Generally, ESI form 53 is required when insured person transfers from one job location to another job location or when insured person finds any incorrect details mentioned in ESIC employee portal. It is always a good idea to correct any incorrect details in ESIC portal, so that insured person and his or her family members won’t get any problems during ESIC treatment.

↓  Download ESIC Form 53

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Sample Filled ESIC Form 53 Or How To Fill ESIC From 53

This form consists two sections one section is to change ESIC local office and ESIC Dispensary and here we need to write the reason for the change.  The second section is to change employee name, employee relation ship details, date of birth and address.

Sample Filled ESIC Form 53

sample filled esic form 53

↓ Download  Sample Filled ESIC Form 53

The changes may take with in 30days. But recently employee state insurance corporation has made every thing online, insured persons can able to change their dispensaries online but it is not possible to change employee name and date of birth in online, so in this cases, insured persons need to submit ESIC Form 53 to their regional ESIC office.


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