The Social Security (Central) Rules, 2026
Form XXVIII
Official text
Open in the official PDF (pp. 257–258)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
[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.