Rule Form XXVIII Form XXVIII
- Chapter
- Annexures · Forms and Appendices
- Text as on
- As notified 08 May 2026
FORM-XXVIII [See rule 59(2)]
Certificate by the applicant To
The Competent authority for Employee`s Compensation
It is hereby submitted that: - I/We hereby declare that the particulars given in Form XXVII are true to the best of my/our knowledge and belief and I/We hereby declare that nothing has been concealed or no fact has been mis-represented in the above said form made by me/us.
Dated:
Applicant.