Form 23 - Life Certificate for Permanent Disablement Benefit

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

This certificate must be issued by one of the following:

1. 1. An officer of the Revenue, Judicial, or Magisterial Department
2. 2. A Municipal Commissioner
3. 3. A Workmen's Compensation Commissioner
4. 4. The Head of a Gram Panchayat, under the official seal of the Panchayat
5. 5. An M.L.A. or M.P.
6. 6. A Gazetted Officer of the Central or State Government
7. 7. A member of the Regional Board or Local Committee of the ESIC
8. 8. Any other authority the concerned Branch Manager considers appropriate

Form 23