Self-Declaration Form For Insured Woman Relating To Maternity Benefit Under ESI Scheme Introduced

As per ESIC circular dated 18th July 2017, the ESIC has introduced a Self-declaration Form for the Insured Woman. The ESIC had noticed some instances, that the family particulars of IP/IW vary from those available in the IP portal which lead to undue benefit. In order to obviate this issue, it has been decided to obtain a self declaration from the Insured Woman for number of her surviving children as on date of presenting the maternity benefit claim. If there is an inconsistency between the declaration and the particulars on the portal, then 12 week of maternity benefit would be paid immediately from the ESIC Branch. Remaining payment, if any, will be made to Insured womanwithin 14 days subject to verification. Thus, Insured woman shall now submit self-declaration Form along with claim form No. 19 for the settlement of Maternity Benefit Claim

Any False statement or representation for the purpose of obtaining benefit will be punishable with imprisonment for a term which may extend to six months or with a fine of Rs 2000/- or with both.

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