Basic Employer Information

• Name of the establishment as per ESIC registration records.
  
• 17-digit employer code assigned during registration.
  
• Complete address of the business or branch office.
  
• Email ID and contact number of the authorized signatory.
  
• Contribution period for which the return is being filed.
  

Employee Details Section

• Name of each insured employee covered under ESIC.
  
• ESIC insurance number allotted to each employee.
  
• Date of joining the organization and, if applicable, exit date.
  
• Number of days worked during the contribution month.
  
• Employee category and gender if required in the template.
  

Wage and Contribution Details

• Gross monthly wages paid to each covered employee.
  
• Calculation of 0.75% employee share of contribution.
  
• Calculation of 3.25% employer share of contribution.
  
• Total ESIC amount payable for each individual.
  
• Sum of all employee and employer contributions for the return.
  

Payment and Challan Information

• Challan number generated during online payment.
  
• Date of challan generation and payment submission.
  
• Bank name or payment gateway used for transaction.
  
• Amount paid as per the generated challan.
  
• Confirmation number for successful online transaction.
  

Declaration and Submission

• Confirmation that the details provided are accurate and true.
  
• Name and designation of the employer or authorized person.
  
• Signature or digital verification through portal submission.
  
• Date of submission of the return on the portal.
  
• Downloadable acknowledgment issued by the ESIC system.