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Union of India - Section

Section 62 in The Employees' State Insurance (Central) Rules, 1950

62. Bar on grant of cash benefits. - Where an insured person is convicted under section 84 of the Act, he shall not be entitled to any cash benefit admissible under the Act for a period of three months for first conviction and six months for each subsequent conviction from the date of receipt of judgment of the Court in the concerned office of the Corporation.

FORMSForm I[See rule 21]
Book No. ReceiptNo. Book No. ReceiptNo.
Received from................... the sum of Rs.................(in words).......................... on account of................ Rs....................... Received from................... the sum of Rs.................(in words).......................... on account of................ Rs.......................
  Chief A/c. Officer   Chief A/c. Officer
  ......................   ......................
  Authorized Officer   Authorized Officer
  Entered in Cash Book, Page No.   The Employees' State Insurance Corporation
Accountant[FORM IIApplication To Medical Appeal Tribunal[See rule 20A-(2)]I, ............................................... (full name of appellant) of ......................................... (address of appellant) Appeal against the decision on ....................................................... (date) of the medical board at ................................. (address) notified to me by letter (from ............................) dated ................... that:-*(1)there is no appreciable disablement;*(2) the disablement should continue to be treated as temporary and the next date when the case should be referred to the Medical Board is; or*(3) the disablement can be declared to be of a permanent nature; and
(i)the extent of loss of earning capacity can be assessed provisionally or finally,
(ii)the assessment of the proportion of loss of earning capacity whether provisional or final; and
(iii)in case of provisional assessment, the period for which such assessment shall hold good.
The following are the grounds of my appeal :List of documents, if any:Date ..........................................................................................Signature of appellant*Delete whichever does not apply.The statement of facts contained in this application is to the best of my knowledge and belief true and correct........................................Signature of appellantToChairman of Medical Appeal Tribunal.]