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Employee Welfare Fund Form

An employee welfare fund form enrolls an employee as a member of a company-run staff welfare fund, records their voluntary monthly contribution and authorises the payroll deduction. It explains how the fund is used, such as death or medical emergency support, and whether the company matches contributions.

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[Company Logo][Company Name]

EMPLOYEE WELFARE FUND MEMBERSHIP FORM

Fund:: [Company Name] Staff Welfare Fund
Managed by:: Welfare Committee, [Work Location]
Form No.:: [Reference Number]
Date:: [Date]

Member Details

Employee Name
Employee ID
Department
Designation
Date of Joining
Mobile Number

Contribution

Contribution Option	Employee (₹/month)	Company Matching (₹/month)	Select
Basic	[Amount]	[Amount]	[ ]
Standard	[Amount]	[Amount]	[ ]
Enhanced	[Amount]	[Amount]	[ ]

Purposes the Fund May Support

Financial support to the family on death of a member
Medical emergencies not fully covered by insurance
Natural calamity or accident affecting a member's home
Other purposes approved by the Welfare Committee as per fund rules

Key Rules

Membership is voluntary and starts from the payroll month after this form is received.
Contributions are not refundable on exit unless the fund rules provide otherwise.
Assistance is decided by the Welfare Committee based on the fund's rules and available balance.
Accounts of the fund will be shared with members at least once a year.
A member may withdraw by giving written notice; deductions stop from the next payroll.

Deduction Consent

I wish to become a member of the [Company Name] Staff Welfare Fund and authorise deduction of ₹[Amount] per month from my salary towards my contribution until I withdraw in writing.

Member
[Employee Name]
Date: [Date]

Welfare Committee
[Name]
Membership No.: [Number]

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What this template includes

Fund name, purpose and managing committee
Contribution amount and company matching, if any
Benefits the fund may support
Payroll deduction consent
Membership withdrawal and exit rules
Statement that this is separate from any statutory labour welfare fund contribution

When to use it

When a company or staff committee sets up a welfare fund
At joining, for employees choosing to become members
When the contribution rate is revised
When an employee withdraws membership

How to customise this template

1Insert your fund's rules, committee names and bank account
2Set the contribution slabs
3Mention how often accounts are shared with members
4Check whether your state has a statutory labour welfare fund and describe it separately

HR tips

Keep the fund's accounts transparent and shared at least annually
Make membership voluntary and written
Do not confuse this with the state labour welfare fund deduction where applicable
Define who approves disbursements to avoid disputes

Several states levy a statutory labour welfare fund contribution with its own rules. This voluntary company fund form does not replace those obligations; review with your compliance adviser.

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Frequently asked questions

What is an employee welfare fund?+

A pool of money, often from employee contributions and sometimes matched by the company, used to support members in emergencies such as illness or bereavement.

Is labour welfare fund the same as a company welfare fund?+

No. The labour welfare fund is a statutory contribution in some states, while a company welfare fund is a voluntary internal scheme.

Can I get my welfare fund contributions back when I leave?+

That depends on the fund's rules; many internal funds are non-refundable because they work like mutual support.

All 50 employee benefits & insurance →

[Company Logo][Company Name]
EMPLOYEE WELFARE ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Handling:
Confidential
Applicant
Employee Name (or family member applying on behalf)
Employee ID
Department
Years of Service
Mobile Number
Nature of Hardship
- Medical emergency (self or dependant)
- Death in the family
- Natural calamity / fire / accident to property
- Other serious hardship: [Details]
Details of Need
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[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
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Employee Benefits Enrollment Form
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Employee Name (or family member applying on behalf)
Employee ID
Department
Years of Service
Mobile Number

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]

EMPLOYEE INSURANCE DETAILS FORM

Company:: [Company Name]
Record Date:: [Date]
Last Updated:: [DD/MM/YYYY]

Employee Information

Employee Name
Employee ID
Designation
Department
Work Location
Date of Joining
Mobile Number

Coverage Summary

Cover	Insurer	Policy No.	Member / E-card ID	Sum Insured (₹)	Valid Till
Group Mediclaim	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Term Life	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Group Personal Accident	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]
Voluntary Top-up	[Insurer Name]	[Policy Number]	[Member ID]	[Amount]	[DD/MM/YYYY]

Statutory Coverage

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Member Name (as currently on e-card)
Relationship
E-card / Member ID

[Company Logo][Company Name]

EMPLOYEE WELLNESS PROGRAM: NEEDS AND INTEREST FORM

Company:: [Company Name]
Survey Period:: [DD/MM/YYYY] to [DD/MM/YYYY]
Coordinator:: [HR Name]

We are planning our wellness calendar for [Year]. Your answers will help us choose activities that suit you. Questions about health are optional and responses will be reported only in aggregate.

About You (optional)

Name (optional)
Department
Work Location
Work Pattern: General Shift / Rotational Shift / Remote / Hybrid
Age Group: Under 25 / 25-34 / 35-44 / 45-54 / 55+

Rate Your Interest (1 = low, 5 = high)

Programme	Interest (1-5)	Preferred Format
Yoga and stretching	[1-5]	[On-site / Online]
Gym or fitness challenge	[1-5]	[On-site / App]
Nutrition and diet talks	[1-5]	[On-site / Online]
Stress management and mental health	[1-5]	[On-site / Online]
Sleep and lifestyle workshops	[1-5]	[Online]
Financial wellness (tax, savings)	[1-5]	[Online]
Preventive health check-up	[1-5]	[On-site / Lab]

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[Company Logo][Company Name]
EMPLOYEE ASSISTANCE PROGRAMME (EAP) REQUEST FORM
Company:
[Company Name]
EAP Provider:
[Provider Name]
24x7 Helpline:
[Phone Number]
Date:
[Date]
Confidentiality: Your request goes to [Provider Name]. The company receives only anonymous, aggregated usage data. Information is shared only with your consent or where there is a serious risk to safety. If you are in immediate danger, call [Emergency Number] or go to the nearest hospital.
Who Needs Support
Name of Person Seeking Support
Relationship to Employee: Self / Spouse / Child / Parent
Employee ID (for eligibility check only)
City
Type of Support
- Emotional wellbeing and counselling
- Work stress or relationship at work
- Family or relationship concerns
- Legal information and guidance
- Financial and debt guidance
- Childcare or eldercare information
- Grief or critical incident support
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Name of Person Seeking Support
Relationship to Employee: Self / Spouse / Child / Parent
Employee ID (for eligibility check only)
City

[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

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Benefits Selection Form

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[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)

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Employee Welfare Fund Form

Preview of the form

Member Details

Contribution

Purposes the Fund May Support

Key Rules

Deduction Consent

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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