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Form guide · Source checked 21 October 2026
ESIC Form 8: special intermediate certificate
A longer-interval medical certificate after the Regulation61 conditions, not an ordinary weekly intermediate certificate or an automatic28-day entitlement.
Identified 1950 Regulations form / saved transition and online procedure; checked 21 October 2026
Download and read the completed example
Fictional prolonged-sickness example. Next review27 October is a prospective teaching assumption as of21 October2026; no current fitness or benefit award is certified.
Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.
When and how this form is used
Regulation61 needs sickness/temporary disablement continuing for not less than28 days, IMO satisfaction that it is likely to continue, and a condition for which treatment/examination less often than weekly is sufficient. These are separate conditions; crossing day28 alone does not authorise this certificate.
The longer interval specified by the IMO cannot exceed four weeks under Regulation61. The model’s29 September→27 October interval is28 days. Do not copy older manual acceptance discussions about42 days as the ordinary permitted interval.
The printed form’s Regulations61 and89-B apply to the relevant sickness/disablement or maternity-related sickness branch. The selected model is ordinary prolonged sickness. Deposit the genuine certificate within3 days; the model assumes submission30 September2026, one day after issue.
The completed fields
Special intermediate certificate
| Prescribed field / section | Completed fictional entry |
|---|---|
| Serial / dispensary stamp | DEMO-SPECIAL-01 [synthetic]; stamp not executed |
| First certificate / person / parent / IP | 1 September2026; Ravi Kumar, son of Meera Kumar; [synthetic IP DEMO-0001; not a valid insurance number] |
| Employer / Branch Office | [synthetic employer code DEMO-ESI; not valid]; appropriate ESIC Branch Office, New Delhi |
| Examination / continued inability / diagnosis | 29 September2026; hypothetical continuing incapacity since1 September; fictional prolonged recovery from a non-work-related fracture, no real diagnosis |
| Interval / projected incapacity | IMO opinion assumed that treatment/examination every4 weeks is sufficient; next review27 October2026; anticipated incapacity at least4 weeks from29 September, subject to clinical change |
| Medical Board branch | Need not be referred now on the expressly temporary hypothetical condition; actual IMO determines referral, not the website |
| Remarks / medical attestation | No other remark; actual condition may require earlier attendance; Unsigned fictional teaching entry; signature, seal, photograph attestation and official issue NOT executed |
| Patient signature / IMO signature / name / rubber stamp | All not executed. Illustrative Dr Fictional Medical Officer is not a real certifier; no registration number fabricated |
Supporting records and reconciliation
Actual first/weekly certificates, continuous incapacity and clinical chronology, IMO’s longer-interval assessment, current examination/diagnosis and genuine signed certificate, timely submission, any Medical Board referral and separate benefit claim.
Worked calculation: 1 September→29 September=28 elapsed days;29 September→27 October=28 days/four weeks; submission30 September is one day after issue.
Official source and version
Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.
These are the identified ESI (General) Regulations 1950 forms and the online procedures described by ESIC. Code on Social Security section164(2)(b) saves the earlier ESI rules/regulations for one year from commencement to the extent consistent. The 13 July 2026 instrument published in Gazette274902 is expressly a DRAFT inviting objections; it cannot by itself substitute these forms. The examples are source-checked on 21 October 2026 within the identified transition, not a claim that an old paper layout is the current portal screen.
Practical questions
Can I submit the sample as my own completed form?
No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.
What makes the example specific to this form?
A longer-interval medical certificate after the Regulation61 conditions, not an ordinary weekly intermediate certificate or an automatic28-day entitlement.