Rules and Regulations of India

Law Library of Rules and Regulations of India


FORM 13: Sickness or Temporary Disablement or Maternity Benefit for Sickness

[Regulations 63 and 89B]


    I______________________ son/wife/daughter of ________________ Insurance No ____ declare that, because of sickness/temporary disablement, I have not been at work since the date mentioned in the first/last certificate sent to you.

    23[I have not been in receipt of wages on account of leave, holidays. I was not on strike during the period of certified abstention for which benefit is claimed.]

    I claim benefit accordingly. I desire payment in cash at local office/by money order.

Dated ______

Signature or thumb impression

Local office _______

Present address (if changed)___________

Notes: (1) Any person who makes a false statement or representation for the purpose of obtaining benefit whether for himself or for some other person renders himself liable to prosecution.

(2) This form should be completed and sent without delay to the appropriate local office.

(3) The insured person should obtain a final certificate before resuming work.

Main Index

Rules and Regulations of India


Leave a Reply

Your email address will not be published. Required fields are marked *

Copyright © 2021 Rules and Regulations of India

Free Legal Help, Just WhatsApp Away

MyNation HELP line

We are Not Lawyers, but No Lawyer will give you Advice like We do

Please read Group Rules – CLICK HERE, If You agree then Please Register CLICK HERE and after registration  JOIN WELCOME GROUP HERE

We handle Women Centric biased laws like False Section 498A IPC, Domestic Violence(DV ACT), Divorce, Maintenance, Alimony, Child Custody, HMA 24, 125 CrPc, 307, 312, 313, 323, 354, 376, 377, 406, 420, 497, 506, 509; TEP, RTI and many more…

MyNation FoundationMyNation FoundationMyNation Foundation