Download ESIC FORM :14 CLAIM FOR PERMANENT DISABLEMENT BENEFIT EMPLOYEE.S STATE INSURANCE CORPORATION

 Download ESIC FORM – 14

As per Regulation 76 – A  Submission of claims for permanent disablement benefit

An insured person who has been declared to be permanently disabled by a Medical Board or by an Appeal Tribunal shall submit, by post or otherwise, to the appropriate [branch office] a claim, covering, except in the case of a first payment, a period of one or more complete calendar months in [Form 14] for claiming permanent disablement benefit.

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