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Dependents Declaration Form

A dependents declaration form lists the family members an employee wants covered under company benefits such as group health insurance, with their dependency status and proofs. HR uses it to enrol dependants and to process additions or deletions during the policy year.

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[Company Logo][Company Name]

DEPENDENTS DECLARATION FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Policy Year:: [YYYY-YY]
Action:: New enrolment / Addition / Deletion

1. Benefits Covered by This Declaration

Group medical insurance
Group personal accident (family floater, if any)
Other dependant benefit: [Specify]

2. Dependant Details

Name	Relationship	Date of Birth	Gender	Financially Dependent (Yes / No)	Other Health Cover (Yes / No)
[Name]	Spouse	[DD/MM/YYYY]	[Gender]	[Yes / No]	[Yes / No]
[Name]	Child	[DD/MM/YYYY]	[Gender]	[Yes / No]	[Yes / No]
[Name]	Child	[DD/MM/YYYY]	[Gender]	[Yes / No]	[Yes / No]
[Name]	Parent / Parent-in-law	[DD/MM/YYYY]	[Gender]	[Yes / No]	[Yes / No]

3. Mid-Year Change (if applicable)

Event (marriage / birth / death / over-age / other)
Date of Event
Dependant to be added or deleted

4. Proofs Attached

Marriage certificate or spouse ID
Birth certificate of child
ID proof of parents
Other: [Specify]

Declaration

I declare that the persons listed are my dependants as defined in the company's benefit policy and that the details are correct. I understand that wrong information may lead to rejection of claims and recovery of amounts paid.

Signature of Employee
[Employee Name]
Date: [Date]
Place: [Work Location]

Benefits Desk
[HR Name]
Sent to insurer on: [Date]

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What this template includes

Benefit type the declaration applies to
Dependant name, relationship, date of birth and gender for the insurer
Dependency status and whether the dependant has other cover
Add or delete action with event date
Proof of relationship list
Option to cover parents or parents-in-law as per policy

When to use it

At joining, to enrol dependants in group medical cover
When adding a spouse after marriage or a newborn child
At policy renewal when dependant data is refreshed
When a dependant becomes ineligible, such as an over-age child

How to customise this template

1Insert your policy's eligible relationships and age limits
2Add premium sharing details for parental cover if any
3Add the timeline within which mid-year additions must be reported, as per your policy
4Remove benefits you do not offer

HR tips

Check names and dates of birth match ID proofs to avoid claim rejection
Report newborns and new spouses quickly as policies have windows
Do not enrol both parents and parents-in-law unless the policy allows
Share the e-card once enrolment is done

Eligibility and timelines depend on the insurer's policy; confirm with your broker before finalising this form.

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Frequently asked questions

Who can be a dependant under group health insurance?+

Usually spouse and children, and sometimes parents or parents-in-law, depending on the company policy and insurer terms.

Can I add a dependant in the middle of the year?+

Most policies allow additions after marriage or childbirth if reported within a set time. Check your policy.

What proof is needed for dependants?+

Typically a marriage certificate or ID with spouse name for spouses, a birth certificate for children and ID proof for parents.

All 50 joining & new employee documents →

[Company Logo][Company Name]

NOMINEE DECLARATION FORM (COMPANY DUES)

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Designation:: [Designation]
Date of Joining:: [Date of Joining]

1. Scope of Nomination

This nomination covers amounts payable by [Company Name] in the event of my death while in service, including unpaid salary, leave encashment, pending reimbursements, performance bonus or incentive due, and any other company benefit not covered by a separate statutory nomination.

2. Nominee Details

Nominee Name	Relationship	Date of Birth	Address	Share (%)
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address]	[%]

3. Guardian Details (if any nominee is a minor)

Form · Word

Employee Nominee Declaration Form

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[Company Logo][Company Name]
PAN DECLARATION FORM
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Financial Year:
[YYYY-YY]
Section A: PAN Details
PAN
Name exactly as on PAN
Father's Name as on PAN
Date of Birth as on PAN
PAN linked with Aadhaar (Yes / No / Not sure)
Section B: If PAN Is Not Yet Available
Date of PAN Application
Acknowledgement Number
Expected Date of Receipt
Section C: Name Difference (if any)
Form · Word
PAN Declaration Form
Download .docx
[Company Logo][Company Name]
AADHAAR DECLARATION AND CONSENT FORM
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Date:
[Date]
1. Aadhaar Details
Name as on Aadhaar
Aadhaar (last 4 digits only): XXXX XXXX [Last 4 Digits]
Copy submitted (Masked copy / Not submitted)
Mobile number linked to Aadhaar (Yes / No)
2. Purpose of Collection (tick what applies)
- Linking with UAN / EPF records
- Identity verification at joining
- Other purpose: [Specify]
3. Alternate Identity Document (if Aadhaar not provided)
Form · Word
Aadhaar Declaration Form
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PAN
Name exactly as on PAN
Father's Name as on PAN
Date of Birth as on PAN
PAN linked with Aadhaar (Yes / No / Not sure)

Date of PAN Application
Acknowledgement Number
Expected Date of Receipt

Name as on Aadhaar
Aadhaar (last 4 digits only): XXXX XXXX [Last 4 Digits]
Copy submitted (Masked copy / Not submitted)
Mobile number linked to Aadhaar (Yes / No)

[Company Logo][Company Name]

UAN DECLARATION FORM (INTERNAL)

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Date of Joining:: [Date of Joining]
Establishment:: [Company Name]

Note: This is an internal company declaration. The official EPFO forms and online processes will also be completed where required.

A. Previous PF Membership

Were you a member of PF earlier? (Yes / No)
Do you have a UAN? (Yes / No)
UAN (if Yes)
Is the UAN activated on the member portal? (Yes / No)
Do you have more than one UAN? (Yes / No) – give details

B. Previous Employment PF History

Previous Employer	PF Member ID	Date of Joining	Date of Exit	PF Settled / Not Settled
[Employer]	[Member ID]	[DD/MM/YYYY]	[DD/MM/YYYY]	[Status]
[Employer]	[Member ID]	[DD/MM/YYYY]	[DD/MM/YYYY]	[Status]
[Employer]	[Member ID]	[DD/MM/YYYY]	[DD/MM/YYYY]	[Status]

Form · Word

UAN Declaration Form

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[Company Logo][Company Name]
ESIC DECLARATION FORM (INTERNAL)
Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Date of Joining:
[Date of Joining]
ESIC Employer Code:
[Code]
Note: This is an internal company form. Official registration will be completed by HR on the ESIC portal.
1. Eligibility
Gross monthly wages: ₹[Amount]
Covered under ESI (Yes / No – to be filled by HR)
2. Previous ESI Coverage
Were you covered under ESI earlier? (Yes / No)
Existing IP Number
Previous Employer Name and Code
Form · Word
ESIC Declaration Form
Download .docx

Gross monthly wages: ₹[Amount]
Covered under ESI (Yes / No – to be filled by HR)

Were you covered under ESI earlier? (Yes / No)
Existing IP Number
Previous Employer Name and Code

[Company Logo][Company Name]

FAMILY DETAILS DECLARATION FORM

Employee Name:: [Employee Name]
Employee ID:: [Employee ID]
Department:: [Department]

1. Immediate Family

Name	Relationship	Date of Birth / Age	Occupation	City
[Name]	Father	[Age]	[Occupation]	[City]
[Name]	Mother	[Age]	[Occupation]	[City]
[Name]	Spouse	[Age]	[Occupation]	[City]
[Name]	Child	[Age]	[Occupation]	[City]
[Name]	Sibling	[Age]	[Occupation]	[City]

2. Relatives Working in [Company Name] or Group Companies

Name	Relationship	Department	Designation
[Name]	[Relationship]	[Department]	[Designation]
[Name]	[Relationship]	[Department]	[Designation]

3. Relatives Linked to Vendors, Customers or Competitors

Form · Word

Family Details Declaration Form

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[Company Logo][Company Name]
NEW EMPLOYEE JOINING FORM
Company:
[Company Name]
Employee ID:
[Employee ID]
Date of Joining:
[Date of Joining]
Please fill all sections in capital letters and attach self-attested copies of the documents listed in Section 7. Paste a recent passport-size photograph in the box provided.
1. Personal Details
Full Name (as per PAN)
Father's / Spouse's Name
Date of Birth (DD/MM/YYYY)
Gender
Marital Status
Blood Group
Nationality
Mobile Number
Personal Email ID
Aadhaar (last 4 digits / masked copy)
2. Address
Current Address with PIN Code
Permanent Address with PIN Code
Years at Current Address
Form · Word
New Employee Joining Form
Download .docx
[Company Logo][Company Name]
NEW EMPLOYEE INFORMATION FORM
Company:
[Company Name]
Expected Date of Joining:
[Date of Joining]
Section 1: Basic Information
Full Name
Preferred Name (for email and ID card)
Mobile Number
Personal Email ID
City of Residence
Section 2: Role Information (to be pre-filled by HR)
Designation [Designation]
Department [Department]
Reporting Manager [Reporting Manager]
Work Location [Work Location]
Work Pattern (Office / Hybrid / Remote / Shift)
Section 3: IT and Access Requirements
Form · Word
New Employee Information Form
Download .docx

Full Name (as per PAN)
Father's / Spouse's Name
Date of Birth (DD/MM/YYYY)
Gender
Marital Status
Blood Group
Nationality
Mobile Number
Personal Email ID
Aadhaar (last 4 digits / masked copy)

Current Address with PIN Code
Permanent Address with PIN Code
Years at Current Address

Full Name
Preferred Name (for email and ID card)
Mobile Number
Personal Email ID
City of Residence

Designation	[Designation]
Department	[Department]
Reporting Manager	[Reporting Manager]
Work Location	[Work Location]
Work Pattern (Office / Hybrid / Remote / Shift)

Dependents Declaration Form

Preview of the form

1. Benefits Covered by This Declaration

2. Dependant Details

3. Mid-Year Change (if applicable)

4. Proofs Attached

Declaration

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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