Report of an accident and deposit of compensation with the competent authority
A single format from the Employee's Compensation pack. Chapter VII, Code on Social Security 2020 · report of death or serious bodily injury within 7 days · death compensation only by deposit.
- 10 pages
- 115
- Word and PDF
- 30 October 2026
- 30 October 2026
What it covers
- 1Report of an accident and deposit of compensation with the competent authorityChapter VII, Code on Social Security 2020 · report of death or serious bodily injury within 7 days · death compensation only by deposit
Not included
What you will still need outside this format:
- The OSH Code notice of the accident and the register of accidents: see OSH Formats (FV10-G11).
- The accident report for an insured person to the ESI Branch Office: see ESI Formats (FV10-D10).
- The medical assessment of loss of earning capacity by a qualified medical practitioner.
- Gratuity, provident fund, pension and EDLI claims on death: see Gratuity Formats (FV10-E6) and PF Formats (FV10-C13).
- The State's prescribed forms under the Code for the report and the deposit, where notified.
- Proceedings and appeals before the competent authority or the High Court, which need counsel, and the claim on the employer's liability insurer.
Read the opening
The first part of the format, as it downloads. Blanks are highlighted.
On the letterhead of the establishment. For an employee who was not an insured person under the ESI chapter. Compute first with the "Employee's compensation computation and statement" in this pack
This format contains the report to the competent authority of an accident causing death or serious bodily injury (Part A), the letter depositing compensation (Part B), the statement of particulars that goes with the deposit (Part C), the letter to the employee or the dependants (Part D) and the reply to a notice from the competent authority about a fatal accident (Part E). The statutory notice of the accident under the OSH Code is separate and comes first: use the "Notice of accident or dangerous occurrence" and make the entry in the "Register of accidents and dangerous occurrences". For an insured person, use the "Accident report to the Branch Office" instead of this format. The competent authority is the authority appointed by the appropriate Government for the area under Chapter VII; where the State has not yet notified one, the Commissioner for Employees' Compensation for the area continues to receive these papers in practice. Confirm the office before filing.