Legacy Form 12: Accident report
Form-to-regulation crosswalk and current ESIC workflow caution.
How to use this form reference
This page preserves the saved form-to-regulation relationship without representing the paper form as the only current filing channel.
Before filing, check the ESIC portal, current ESIC circulars, medical instructions and any replacement General Regulations. Preserve the submitted data, acknowledgement and supporting evidence even where the interface no longer resembles the legacy form.
Linked regulations
Data-quality checklist
- Correct employer code and insured-person number.
- Event and submission dates.
- Wage, contribution, medical or accident facts according to the form.
- Authorised signatory or medical certification.
- Portal/branch-office acknowledgement and correction history.