Download ESIC REG. FORM-16
As per ESIC Regulation 83 – A. Submission of claims for periodical payments of dependants’ benefit
Each dependant whose claim for dependants’ benefit is admitted under regulation 82, shall submit to the appropriate [branch office], by post or otherwise, a claim covering, except in the case of first or a final payment, a period of one or more complete calendar months in [Form 16]. Such claim may be made by the legal representative of a beneficiary or in the case of a minor by his guardian.