Free template template · Word

Benefit Cost Statement

A benefit cost statement is an internal HR and finance sheet that totals what the company spends on each employee benefit, such as PF and ESI employer share, gratuity provision, group insurance premiums and perks, against budget. It shows headcount covered, cost per employee and variance, to support renewals and budgeting.

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[Company Logo][Company Name]

EMPLOYEE BENEFIT COST STATEMENT

Company:: [Company Name]
Period:: [Quarter / FY 20XX-XX]
Prepared by:: [HR Name]
Date:: [Date]

A. Statutory Benefits

Benefit	Employees Covered	Employer Cost (₹)	Cost per Employee (₹)	Budget (₹)	Variance (₹)
EPF and EPS Employer Contribution	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
ESI Employer Contribution	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Gratuity Provision / Premium	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Labour Welfare Fund (where applicable)	[Number]	[Amount]	[Amount]	[Amount]	[Amount]

B. Insurance Benefits

Benefit	Lives Covered	Employer Cost (₹)	Cost per Employee (₹)	Budget (₹)	Variance (₹)
Group Mediclaim	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Group Term Life	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Group Personal Accident	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Employee Compensation Policy	[Number]	[Amount]	[Amount]	[Amount]	[Amount]

C. Voluntary and Lifestyle Benefits

Benefit	Participants	Employer Cost (₹)	Cost per Participant (₹)	Budget (₹)	Variance (₹)
Canteen Subsidy	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Transport	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Wellness and EAP	[Number]	[Amount]	[Amount]	[Amount]	[Amount]
Education Assistance	[Number]	[Amount]	[Amount]	[Amount]	[Amount]

D. Summary

Category	Total Cost (₹)	% of Total Benefits Cost	Budget (₹)	Variance (₹)
Statutory	[Amount]	[%]	[Amount]	[Amount]
Insurance	[Amount]	[%]	[Amount]	[Amount]
Voluntary	[Amount]	[%]	[Amount]	[Amount]
Total	[Amount]	100%	[Amount]	[Amount]

E. Commentary

Key drivers of variance: [Headcount change / premium revision / claims experience]
Group health claims ratio for the policy year (as per broker): [%]
Recommendations for renewal or budget: [Details]

Prepared by
[HR Name]
Date: [Date]

Reviewed by
[Authorised Signatory]
Finance

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What this template includes

Benefit-wise employer cost table
Headcount or lives covered per benefit
Cost per employee per year
Budget versus actual with variance
Statutory versus voluntary split
Commentary on drivers such as claims ratio or headcount growth

When to use it

Quarterly or annual review of benefits spend
Before group insurance renewal negotiations
Annual budgeting for the next financial year
Board or management reporting on people costs

How to customise this template

1List all benefits you fund, including statutory ones
2Pull premium figures from insurer invoices and endorsements
3Use your accounting period, monthly or quarterly
4Add location-wise columns if you have multiple sites

HR tips

Separate employee-paid premiums so employer cost is not overstated
Track the group health claims ratio from the broker's report
Explain big variances in the commentary
Do not share individual salary data in this aggregate report

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Frequently asked questions

What is included in employee benefit cost?+

Employer PF and ESI contributions, gratuity provision, group insurance premiums, meal, transport and wellness spend, and other perks the company funds.

How is cost per employee for benefits calculated?+

Divide the total employer cost for a benefit by the number of employees covered during the period.

Is a benefit cost statement the same as a benefits statement?+

No. A benefit cost statement is an internal aggregate report for management, while a benefits statement is given to an individual employee.

All 50 employee benefits & insurance →

[Company Logo][Company Name]
MEAL BENEFIT ENROLLMENT FORM
Company:
[Company Name]
Meal Card Vendor:
[Vendor Name]
Effective From:
[DD/MM/YYYY]
Date:
[Date]
Employee Details
Employee Name
Employee ID
Department
Work Location
Mobile Number (for card KYC)
Email ID
Choose One Option
- Option A: Digital meal card with monthly load of ₹[Amount] (allowed range ₹[Amount] to ₹[Amount])
- Option B: Canteen subsidy at [Work Location]; meals at subsidised rate of ₹[Amount] per meal
- Option C: Opt out; equivalent amount paid as taxable allowance
Salary Impact
Form · Word
Meal Benefit Enrollment
Download .docx
Form · Word
Transport Benefit Enrollment
Download .docx

Residential Address
Nearest Landmark
PIN Code
Preferred Pickup Point / Route No.
Distance from Office (approx. km)

[Company Logo][Company Name]

EMPLOYEE LOAN RECOVERY STATEMENT

Company:: [Company Name]
Statement Date:: [Date]
Loan No.:: [Reference Number]

Loan Summary

Employee Name	Employee ID	Sanctioned (₹)	Disbursed On	Interest	Planned EMI (₹)
[Employee Name]	[Employee ID]	[Amount]	[DD/MM/YYYY]	[Interest-free / Rate%]	[Amount]

Recovery Ledger

Salary Month	Opening Balance (₹)	Planned EMI (₹)	Actual Deducted (₹)	Prepayment (₹)	Closing Balance (₹)	Remarks
[Month Year]	[Amount]	[Amount]	[Amount]	0	[Amount]	-
[Month Year]	[Amount]	[Amount]	0	0	[Amount]	EMI holiday approved
[Month Year]	[Amount]	[Amount]	[Amount]	[Amount]	[Amount]	Part prepayment
[Month Year]	[Amount]	[Amount]	[Amount]	0	[Amount]	-

Position as on Statement Date

Report · Word

Employee Loan Recovery Statement

Download .docx

[Company Logo][Company Name]

YOUR ANNUAL BENEFITS STATEMENT

Employee:: [Employee Name]
Employee ID:: [Employee ID]
Designation:: [Designation]
Period:: [FY 20XX-XX]
Issued on:: [Date]

Dear [Employee Name],

This statement summarises the total value of the pay and benefits [Company Name] provided to you during the period. Thank you for your contribution.

1. Cash Compensation

Component	Annual Value (₹)
Basic Salary	[Basic Salary]
HRA	[HRA]
Special and Other Allowances	[Amount]
Variable Pay / Bonus Paid	[Amount]
Total Cash	[Amount]

2. Retirement and Statutory Benefits

Benefit	Employer Contribution / Value (₹)	Note
Employer PF and EPS	[Amount]	12% of PF wages, subject to wage ceiling rules
Gratuity (accrued estimate)	[Amount]	Payable after 5 years' continuous service, as per law
ESI Employer Share (if applicable)	[Amount]	For wages up to ₹21,000/month
NPS Employer Contribution	[Amount]	If opted

Report · Word

Benefits Statement

Download .docx

[Company Logo][Company Name]
EMPLOYEE BENEFITS ENROLLMENT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date of Submission:
[Date]
Enrollment Deadline:
[DD/MM/YYYY]
Please complete all sections within the enrollment window and return this form to [HR Name], Human Resources. Benefits will be activated only after HR verification.
Section A: Employee Details
Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)
Section B: Statutory Benefits
UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No
Form · Word
Employee Benefits Enrollment Form
Download .docx

Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)

UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No

[Company Logo][Company Name]

FLEXIBLE BENEFITS SELECTION FORM

Company:: [Company Name]
Financial Year:: [FY 20XX-XX]
Submission Date:: [Date]
Payroll Cut-off:: [DD/MM/YYYY]

Part 1: Employee Information

Employee Name
Employee ID
Designation
Department
Annual CTC: ₹[CTC]
Annual Flexi Basket: ₹[Amount]
Tax Regime Opted: Old / New

Part 2: Allocation of Flexi Basket

Component	Company Limit per Month (₹)	My Monthly Allocation (₹)	Annual Allocation (₹)	Bills Required
Meal Card / Food Coupons	[Amount]	[Amount]	[Amount]	No (card based)
Fuel and Vehicle Maintenance	[Amount]	[Amount]	[Amount]	Yes
Telephone and Internet	[Amount]	[Amount]	[Amount]	Yes
Leave Travel Allowance	[Amount]	[Amount]	[Amount]	Yes, travel proof
Books and Periodicals	[Amount]	[Amount]	[Amount]	Yes
Employer NPS Contribution	[Amount]	[Amount]	[Amount]	No
Total (must equal flexi basket)	-	[Amount]	[Amount]	-

Part 3: Terms

Form · Word

Benefits Selection Form

Download .docx

[Company Logo][Company Name]
GROUP MEDICAL INSURANCE (GMC) ENROLLMENT FORM
Policyholder:
[Company Name]
Insurer:
[Insurer Name]
TPA:
[TPA Name]
Policy No.:
[Policy Number]
Policy Period:
[DD/MM/YYYY] to [DD/MM/YYYY]
1. Primary Member (Employee)
Employee Name (as per ID proof)
Employee ID
Date of Birth
Gender
Date of Joining
Work Location
Mobile Number
Email ID
2. Coverage Selection
Sum Insured Tier: ₹[Amount] / ₹[Amount] / ₹[Amount]
Basis: Family Floater / Individual
Voluntary Top-up: Yes / No, Sum Insured ₹[Amount]
Parental Cover: Parents / Parents-in-law / None
3. Family Members to be Covered
Form · Word
Group Medical Insurance Enrollment
Download .docx

Employee Name (as per ID proof)
Employee ID
Date of Birth
Gender
Date of Joining
Work Location
Mobile Number
Email ID

Sum Insured Tier: ₹[Amount] / ₹[Amount] / ₹[Amount]
Basis: Family Floater / Individual
Voluntary Top-up: Yes / No, Sum Insured ₹[Amount]
Parental Cover: Parents / Parents-in-law / None

[Company Logo][Company Name]

GROUP INSURANCE NOMINATION FORM

Company:: [Company Name]
Policy:: Group Term Life / Group Personal Accident
Insurer:: [Insurer Name]
Policy No.:: [Policy Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Department
Date of Birth
Date of Joining
Marital Status

Nominee Details

Nominee Name	Relationship	Date of Birth	Address and Mobile	Share (%)
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
Total				100%

Appointee (only if a nominee is a minor)

Form · Word

Group Insurance Nomination Form

Download .docx

Benefit Cost Statement

Preview of the template

A. Statutory Benefits

B. Insurance Benefits

C. Voluntary and Lifestyle Benefits

D. Summary

E. Commentary

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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