| Wages for ESI this month | — |
| Employee share (0.75%, deducted from salary) | — |
| Employer share (3.25%, paid on top) | — |
| Total paid to ESIC | — |
These wages are above the limit, so ESI does not apply to a new employee. If this person was already covered, tick the box above: contributions continue until the contribution period ends.
An estimate, rounded up to the next rupee as ESIC does. Employees whose average daily wage is up to ₹176 do not pay the employee share, but the employer still pays 3.25%. If there was loss of pay, enter the wages actually earned for the month.