Workmen Compensation

Temporary Total Disability

Duly filled claim form with company seal and signature.

Muster Roll for attendance check.

Wage Register.

Leave certificate from employer.

Medical cum Fitness certificate from treating Doctor confirming the Injury and advising rest/ unfit to work for specified number of days/fitness date.

Indemnity cum declaration bond on Rs. 50 stamp paper.

Covering letter from employer stating description of accident.

GAZETTED/NOTARY attested copy of FIR (If reported to police authority).

NOC from Injured/nominee of deceased if payment to be done in favour of Insured or vice versa.

DEATH CLAIM

Duly filled claim form with company seal and signature.

Muster Roll for attendance check.

Wage Register.

WC award copy (with payment details).

FIR copy (GAZETTED/NOTARY attested).

Death Certificate (GAZETTED/NOTARY attested).

Covering letter from employer stating description of accident.

Valid age proof. 9. Complete post mortem report (GAZETTED/NOTARY attested).

Spot Panchnama/Inquest Panchnama/Panchayatnama in case of panchayat (GAZETTED/NOTARY attested).

NOC from Injured/nominee of deceased/legal heirs if payment to be done in favour of Insured (if already paid).

PERMANENT TOTAL / PARTIAL DISABILITY

Duly filled claim form with company seal and signature.

Muster Roll for attendance check.

Wage Register.

Disability certificate reflecting disability percentage from authorized medical officer/civil surgeon of civil hospital/govt. hospital of the district/units concerned.

Colour Photograph reflecting disability.

Indemnity cum declaration bond on Rs. 50 stamp paper.

Covering letter from employer stating description of accident.

Valid age proof.

GAZETTED/NOTARY attested copy of FIR (If reported to police authority).

Reports like, X-rays and other reports essential for confirmation of the type and percentage of disability.

NOC from Injured/ nominee of deceased if payment to be done in favor of Insured or vice versa.