Form 24 - Declaration & Certificate for Dependent's Benefit

To receive dependent's benefit, the nominee of an insured person has to submit a declaration-cum-certificate of the given format, along with the claims, during June and December.

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 the 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