Employees' State Insurance (General) Regulations, 1950
63. Form of claim for sickness or temporary disablement
An insured person intending to claim sickness benefit or disablement benefit for temporary disablement shall submit to the appropriate local office by post or otherwise, a claim for benefit in one of the Forms 12, 13 and 14, appropriate to the circumstances of the case together with the appropriate medical certificate:
PROVIDED that where only one claim in Forms 13 and 14 is submitted in respect of more than one certificate, such Form 13 or 14 shall be deemed to be appropriate to all such certificates.