| FORM NO. |
SUBJECT |
RELEVANT REGULATION |
TO BE USED BY |
| |
|
|
|
| FORM-9 |
Claim for Sickness/ Temporary Disablement Benefit/Maternity Benefit
|
63 & 89(B)
|
IP/Beneficiary |
| FORM-11 |
Accident Book
|
66
|
Employer |
| FORM-12 |
Accident Report from Employer
|
68
|
Employer |
| FORM-14 |
Claim for Permanent Disablement Benefit
|
76(A)
|
IP/Beneficiary |
| FORM-15 |
Claim for Dependent Benefit
|
80
|
IP/Beneficiary |
| FORM-16 |
Claim for periodical payment of Dependent Benefits
|
83(A)
|
IP/Beneficiary |
| FORM-19 |
Claim for Maternity Benefit and notice of work
|
88, 89 & 91
|
IP/Beneficiary |
| FORM-20 |
Claim for Maternity Benefit after the death of an Insured Women leaving behind the child
|
89(A)
|
IP/Beneficiary |
| FORM-22 |
Funeral Expenses Claim
|
95(E)
|
Beneficiary |
| FORM-23 |
Life Certificate for Permanent Disablement Benefit
|
107
|
IP/Beneficiary |
| FORM-24 |
Declaration and Certificate for Dependents Benefit
|
107(A)
|
IP/Beneficiary |
