Form 23 - Life Certificate for Permanent Disablement Benefit

To claim permanent disablement claim, along with the claims during June and December, the insured person has to submit this certificate also.

This Certificate is to be given by any of the following:

1. an officer of the Revenue, Judicial, or Magisterial Department
2. a Municipal Commissioner
3. a Workmen’s Compensation Commissioner
4. the Head of Gram Panchayat under the official seal of Panchayat
5. an M.L.A./M.P.
6. a Gazetted Officer of the Central/State Govt.
7. a member of the Regional Board/Local Committee of the ESIC
8. any other authority considered appropriate by the Branch Manager concerned