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Employees' State Insurance (General) Regulations, 1950

FORM 26: Certificate for Permanent Disablement Benefit

[Regulation 107]

Insurance No. of permanently disabled person ___________________________________

    Certified that ____________ son/wife/daughter of ____________________ is alive this day the ___________ day of________19___

Date _____________

Signature _____________

Designation _________

(Rubber stamp or seal of the attesting authority or person)





Employees'   State Insurance (General) Regulations, 1950 Back






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