Prescribed formForm XXVIII — Certificate by applicant for compensation claim
Reviewed by CA Nikhil Gupta · Last reviewed 10 September 2026
2-minute answer
Social Security Form XXVIII compensation claim guide: applicability, claimant and incident evidence, supporting records, filing checks and official labour-law sources.
Current-law check: Use this form only with the current Social Security Code/Central Rules workflow and the applicable compensation claim facts. Verify claimant status, employment/incident evidence, medical/death records where relevant, dependency details and the competent authority before filing. Build a claim pack that separately identifies the claimant, employee/member, employer, event date, wage/contribution record, entitlement basis, bank details and every supporting document; reconcile names and dates before submission to avoid an avoidable deficiency.
Use this page to
- Identify the establishment/worker coverage
- Check the Code, Central Rule and State Rule together
- Map notice, approval or filing responsibility
- Preserve service, payroll and authority evidence
Practical control
Separate historical entitlement under repealed legislation from current Code compliance. Record the event date, establishment coverage and applicable Central/State instrument.
Official / primary sources
Related Finin2min guidance
Reviewed for currentness, usability and source quality on 10 September 2026. Where an official source changes after this date, the official source prevails.
Practical filing map, linked provisions, evidence and quality-control checks. Official Gazette/portal format controls.
Form identity
Use control: Download or reproduce the current prescribed format from the official Gazette/portal. This page explains the filing and evidence architecture and is not a substitute blank form.
When this form is used
Certificate by applicant for compensation claim. Confirm the applicant, authority, jurisdiction, filing mode, limitation, fee/deposit, attachments and service method from the linked Rule.
Completion checklist
- Use the correct legal name, establishment/member/worker identifier and current contact details.
- State the triggering event, date, amount, relief or return period consistently with source records.
- Attach order, medical/service/wage/project/contribution documents and authority letter where relevant.
- Sign or authenticate through the permitted electronic/manual method.
- Retain filing acknowledgement, service proof, defect notice, cure and final order/payment.
Failure risks
Wrong jurisdiction, obsolete format, incomplete attachments, inconsistent dates or unproved service can delay benefit, invalidate an appeal/claim, trigger defect cure or create return/record non-compliance. Substantive rights and curable form defects must be distinguished.
Source and review trail
Use the current official instrument, portal or regulator publication before acting. This panel separates the category authority from page-specific references.
This page reflects the published text; publication of a Code or Central Rule does not by itself establish its commencement date or applicability in every State.
- Official starting point
- www.labour.gov.in
Finin2min · Finance & Law Explained in 2 Minutes
Author: CA Nikhil Gupta · Reviewed by CA Nikhil Gupta · Last reviewed 10 September 2026.
Educational purposes only. Exact notified law, rules, schemes, regulator instruments, judicial decisions, state overlays, portal behaviour and facts must be checked before reliance. Verify with a qualified professional.
Practical guide: Form XXVIII — Certificate by applicant for compensation claim
The points below turn Form XXVIII — Certificate by applicant for compensation claim into a practical workflow so that the page can be used for a filing, computation, review or professional working paper rather than only as a definition.
Using this form in practice
Before completing Form XXVIII — Certificate by applicant for compensation claim, identify the exact proceeding, registration or compliance event that has triggered the form. Read the linked rule together with the latest portal/Gazette version, because a form can be prescribed in the rules while the actual filing channel, attachments or workflow is implemented electronically.
Completion checklist
Match legal name, registration identifiers, period, jurisdiction and signatory details to the records already held by the authority. Reconcile every amount/date with the return, notice, order, books or supporting certificate that creates the filing obligation. Do not reuse data from an earlier period without checking it.
Evidence to retain
Keep the submitted form or acknowledgement, working papers used to populate it, authorisation of the signatory, supporting invoices/certificates/notices and proof of submission or service. If the form responds to an officer action, retain that communication and the chronology of your response.
Common failure points
Frequent problems are using an obsolete form version, selecting the wrong period or jurisdiction, inconsistent identifiers, incomplete attachments and treating a generated acknowledgement as proof that the underlying legal requirement was satisfied. Correct the underlying data first rather than only correcting the form.
Five-point final check
- Confirm that Form XXVIII — Certificate by applicant for compensation claim is the correct provision, form or tool for the facts and period.
- Use the latest official version linked on this page and check for a later amendment before filing.
- Reconcile names, identifiers, dates and amounts with the underlying records.
- Keep a short working paper explaining the conclusion and the evidence relied on.
- If a notice, penalty, limitation period or material tax/financial consequence is involved, obtain specialist review before acting.