EsSalud Form 1040: How it is, Completed and MORE

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First of all, before exposing everything concerning with EsSalud Form 1040, We want you to know what the EsSalud Health Social Security consists of. In this regard, it is a public body, created in order to provide coverage to the insured and their rights holders through the granting of health benefits.

Likewise, this Form is used by insured persons who want to request direct payment of economic benefits for breastfeeding, burial, maternity or temporary incapacity to work. Next, we will tell you what it is and how you can obtain it, its usefulness, the process that your application entails and more.

What is the EsSalud Form 1040 like?

First of all, you should know that the EsSalud Form 1040 It is a format established by the Government of Peru as a registration tool or instrument. Which is aimed at any person who is affiliated, on a mandatory or voluntary basis, with any of the insurance offered and administered by EsSalud.

In the same way, we can tell you that this Format contains four (4) sections. In the same way, these must be completed with words, phrases or simply marking with an X (X), depending on the procedure that you are going to request. Also, these mentioned sections are the following:

Owner insured information

  • Here you will place the personal data of the insured holder
  • Complete names
  • Identification number

  • Also include personal data of the employer full names or business name
  • Unique Taxpayer Registration Number
  • Telephone contacts
  • Email address

Beneficiary information

  • This section is to be completed only in the event that the requested financial benefit is for breastfeeding or burial
  • Reason why you must include the beneficiary’s data
  • National identity card number
  • Complete names
  • Email
  • Telephone contact
  • Data of the family member who authorizes, in the case of third parties

Application for financial benefits

  • This is where you will select whether the request is for a direct payment or a refund
  • In this regard, you will have to identify the type of economic benefit in question
  • The start and end date of the contingency
  • The amount and period subsidized, among other data

Additional information

  • This section in turn contains several boxes that have to be completed according to the need of the applicant.
  • As an example we have, put the dates that include the rest period of the first 20 days, in case of temporary disability
  • Within the burial section, you must mark the type of proof of payment that supports the reimbursement
  • In addition to recording other important data regarding the death
  • Thus, in case of reimbursement, you must complete the Affidavit section, which indicates the amount paid to the employee by the employing company
  • Finally, this application must be signed and sealed by the: Employing entity, EsSalud and the Insured or beneficiary (only signature)

Completing the EsSalud Form 1040

Next, we will explain how to enter all the information required by the aforementioned EsSalud Form 1040, in order to do it easily. As well as, know what data you need to fill it, since you must be careful not to put any wrong data, which makes you need a rectification.

  • All the data to be entered must be correct and registered as they appear on the person’s ID
  • Form 1040 must be completed in print and fully legible, if manual
  • Forms containing erasures, erasures or amendments will not be accepted, so you must be very meticulous when filling it out

Section I

  • Information of the insured holder, mark with X the type of Identity Document,
  • Number corresponding to said document
  • Immigration Card or Passport and record the document number
  • In employer data, mark with X the type of identity document, RUC, CIE, with the corresponding number
  • Also register contact email and telephone number

Section II

  • Beneficiary information, only in the case of economic benefit for breastfeeding or burial
  • In the beneficiary’s data, mark with X the type of identity document, DNI, Immigration Card and enter the document number
  • Likewise, enter the paternal surname, maternal surname and names
  • Register email
  • Telephone contact
  • In case of direct family relationship, mark as appropriate, Spouse, Concubine (o), Brother (s), Parents, Other

Section III

  • Application for financial benefits, mark with a cross if it is direct payment or refund
  • Also mark with an X if it is breastfeeding, burial, temporary disability, maternity
  • In case of maternity, indicate if it corresponds to the first armed second armed or total
  • You must mark with X if the insured holder has an employment relationship on the date of the contingency

  • Indicate contingency date, day / month / year
  • Lactation: date of birth of the minor. Maternity: start date of maternity leave
  • Burial: date of death of the insured. Temporary Disability: disability start date
  • If you do not have an employment relationship, indicate the date of termination, day / month / year
  • Enter the subsidized period, start: day / month / year end: day / month / year, also indicate days to subsidize
  • Place amount, amount without cents with rounding to the sun if it is equal to or greater than 0.50
  • In case of being a teaching worker, mark with X if it is private or public

Section IV

  • Additional information, in the first 20 days
  • only for temporary incapacity for work
  • Indicate the requested data
  • Medical College Number
  • Rest period from: day / month / year to: day / month / year

Number of days

What is the EsSalud Form 1040 for? In relation to this point, the EsSalud Form 1040

It is used to register or update the insured and employing entities that require health benefits. That is, the aforementioned 1040 form is a registration instrument where you as the owner or beneficiary provide all the information and data for the required.


In this sense, the use of this tool is of great importance for the benefits of the health system of the Republic of Peru. Likewise, it is vitally useful for citizens to access this registry, in order to obtain benefits and medical health insurance. Therefore, we suggest that you initiate this process properly.

Within this context, the aforementioned benefits are very necessary in the event of occupational diseases or accidents that produce some type of disability. As well as, it can help in cases of deaths or in case of maternity and even breastfeeding at work.

What is EsSalud? Now we want to tell you what it isSocial Health Security

, which is also known as EsSalud, is a decentralized public body in Peru. It was created with the purpose of providing coverage to the insured and their beneficiaries through the granting of health benefits.

Additionally, EsSalud is assigned to the Labor and Social Promotion Sector, with technical, administrative, economic, financial, budgetary and accounting autonomy. As well as, it includes prevention, promotion, recovery and rehabilitation; as well as economic and social benefits for all citizens.

To conclude, this format is intended to provide coverage to the insured and their beneficiaries, through the granting of prevention, promotion, recovery, economic and social benefits. All this, in what corresponds to the contributory regime of Social Security in Health, as well as other human risk insurance.

  • Benefits of Belonging to EsSalud
  • Receive social security benefits in health

    Receive prevention, promotion and health recovery benefits, benefits financial benefits for temporary disability, maternity, breastfeeding and burial benefits

  • The benefits provided are determined based on the type of insurance to which the insured is affiliated and provided that they meet the corresponding accreditation conditions
  • Special coverage for unemployment or latency

  • Complementary Risk Work Insurance
  • Receive timely and quality services. Policyholders must receive timely and quality benefits within a framework of reliability and warmth
  • Receive benefits without any type of discrimination
  • Receive dignified and respectful treatment, with preferential attention to pregnant women, minors, people with disabilities and the elderly
  • Right to present your complaints and reports of misconduct, before the Insured’s Ombudsman or the authorities that they deem pertinent

What is EsSalud Form 1040?

Now, at the end of this article, we want you to know more about what is called EsSalud Form 1040, by the time you need to obtain it. First of all, you should know that Form 1040 is a format established by the Government of Peru as a registration tool or instrument.

Therefore, this form is for the use of the insured when requesting the payment of economic benefits for breastfeeding, burial, maternity or temporary disability. It also constitutes for the employing entities when they request the reimbursement of the subsidies granted to their worker for maternity or temporary incapacity for work.

You should know that this form is applicable to all people who as insured have the right to receive health, economic and social benefits. Consequently, they can enjoy a payment directly, and also the employers through the reimbursement of subsidies stipulated in the legal regulations of Peru.

Protect your health in the best way with EsSalud!

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