Dependant Benefit
Claims

List of documents to be enclosed as evidence for claiming dependants' benefit.

• Evidence that death of the insured person has occurred due to an employment injury in shape of a death certificate issued by an Insurance Medical Officer/Insurance Medical Practitioner on form 17 or ESIC-Med-12, or a certificate of death issued by a hospital or dispensary doctor, or any other medical practitioner who may have been on the spot at the time of death or visited the deceased after death. Municipal death certificate supported by evidence that the insured person died due to employment injury will also be sufficient for the purpose. If the original death certificate is required by the dependents for any legitimate purpose, it may be returned on written request after retaining a copy thereof duly attested by the Manager. This may be done only after the claim has been decided.
   

• Evidence that the claimant/claimants is/are dependant(s). This evidence may be in the form of a declaration by the claimant, supported by counter-signatures of a Magistrate, a Workmen's Compensation Commissioner or Sarpanch of gram panchayat, or a Municipal Commissioner (Form 18).
   

• Evidence of the age of claimant. Proof of the age may be given by means of any of the following documents which should normally be insisted upon:
  Certified extract from an official record of births showing the date and place of birth and father's name.
  Original horoscope prepared soon after birth
  Certified extract from baptismal register.
  Certified extract from school records showing the date of birth and father's name.