Form 24 - Declaration & Certificate for Dependent's Benefit

To receive dependant's benefit, the nominee of an insured person must submit a declaration-cum-certificate on this form, 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 24