Forms XXVII explained: this guide covers what it means, who it applies to, the step-by-step process, documents required, fees, due dates and penalties in India — so you can stay compliant with confidence and avoid costly mistakes.
The last four forms in the Schedule to the Central Rules are all about employee's compensation. Form-XXVII is the application for compensation; Form-XXVIII is the applicant's certificate of accuracy; Form-XXIX is a notice between competent authorities; and Form-XXX is an accident report called for when a matter moves between authorities.
A compensation claim is made in duplicate in Form-XXVII, with a Form-XXVIII certificate signed by the applicant that the facts are true to his knowledge and belief (rule 59). Form-XXIX is the notice a competent authority gives to the authority of the accident area and the State Government before processing an application under section 92 (rule 58(1)). Form-XXX is the detailed report, including records and money, that an authority calls for from the accident-area authority (rule 62(1)).
Where the forms come from
Forms XXVII and XXVIII are cited under rule 59, Form-XXIX under rule 58(1) and Form-XXX under rule 62(1). The rules themselves are in rules 57 to 59 and rules 60 to 62; the Code side is in sections 91 and 92 and sections 93 to 95. The Central Rules apply where the Central Government is the appropriate Government; State-sphere cases follow State rules. If you are preparing or answering a compensation claim, our legal consultation team can help.
| Form | Rule | Who | Purpose |
|---|---|---|---|
| XXVII | 59(1) | Applicant (employee or claimant) | Application for compensation, in duplicate |
| XXVIII | 59(2) | Applicant | Certificate that the facts in Form-XXVII are accurate |
| XXIX | 58(1) | Competent authority | Notice to authority of accident area and State Government |
| XXX | 62(1) | Authority of the accident area | Detailed report on accident with records and money |
Form-XXVII: application for compensation
Rule 59(1). The application may be sent to the competent authority by speed post (with registration) or electronically, or presented to the authority or an authorised subordinate; it is made in duplicate in Form-XXVII and signed by the applicant, unless the authority directs otherwise. A document relied on is appended (59(3)). No fee is stated in rule 59.
Content as printed. It is addressed to the Competent Authority for Employee's Compensation, between the applicant and the opposite party, and says:
- The applicant, employed by (or through a contractor of) the opposite party, received personal injury by accident arising out of and in the course of employment on a stated date; the cause is stated briefly in ordinary language.
- The injuries sustained.
- Monthly wages and whether the applicant is over or under fifteen years of age.
- Notice of the accident: served on a stated date; served as soon as practicable; or not served in due time, with the reason.
- The applicant is entitled to a half-monthly payment for a stated period and/or a lump sum.
- The steps taken to settle by agreement and why settlement was impossible.
- Questions in dispute for determination: whether the applicant is an employee within the meaning of the Code; whether the accident arose out of or in the course of employment; whether the amount claimed is due; whether the opposite party is liable; and any others.
Clauses not applicable are struck out; it is dated and signed by the applicant.
Form-XXVIII: certificate by the applicant
Short, and required: an appended certificate, signed by the applicant, that the statement of facts in the application is accurate to his knowledge and belief (rule 59(2)). As printed, the applicant declares that the particulars in Form-XXVII are true and that nothing has been concealed or no fact misrepresented. It is addressed to the Competent Authority for Employee's Compensation, dated and signed. It is a point for cross-checking in any dispute, so a claimant's representative should read Form-XXVII line by line before the applicant signs.
Form-XXIX: notice to the authority of the accident area
Rule 58(1). An application under section 92(1) is not processed by a competent authority other than the one having jurisdiction over the area of the accident unless that authority gives notice in Form-XXIX, electronically or otherwise, to the competent authority of the accident area and the State Government concerned.
Content as printed. It recites that a claim for compensation has been made by a named applicant against a named person; that the applicant claims to be entitled to file under clause (b) or (c) of section 92(1); and that the undersigned is satisfied of this entitlement. It then gives notice to the competent authority for Employee's Compensation, or Government of a stated State, that the undersigned proposes to settle the claim as provided under the Code. It is dated and signed by the competent authority.
Form-XXX: accident report
Rule 62(1). Where a matter is to be processed by a competent authority other than that of the accident area, the former may, for proper disposal, call for in Form-XXX a detailed report, including transfer of records or money held by the latter, who must comply. If further enquiry is needed in the accident area to frame issues or decide the amount, the former may ask the latter to conduct it and serve notices or orders.
Content as printed. A report about an accident on a stated date and place resulting in death or disablement:
- The employee: name, sex, age; monthly wages; nature of employment; employer's name; full postal address of the employee or dependants (local and permanent); postal address of the factory or establishment and its registered office.
- Circumstances: time and place of the accident; manner in which the deceased or injured was employed at the time; cause of the accident.
- Money deposited by the employer with the competent authority under section 81.
- Compensation paid, if any, and particulars of money invested for the benefit of dependants.
- Documents forwarded in original: death certificate; disablement certificate from the competent medical authority; receipt for deposit of compensation; statement of disbursement; receipt of compensation from the employee or dependants; and any memorandum of agreement.
Practical checklist
- Claimant side: complete Form-XXVII in duplicate; attach Form-XXVIII; append documents such as medical records or an agreement; send by speed post, electronically or in person.
- Employer side: be ready with the section 81 deposit receipt, statement of disbursement and any agreement, because Form-XXX asks for them in original.
- Authority side: give Form-XXIX notice before processing a matter from another area; call Form-XXX for records and money.
- Timing: the rules give no period for these forms; interest on late compensation runs separately under rule 57 (12% simple interest per annum or a notified rate if not paid within thirty days).
Example. A worker injured in an accident applies in Form-XXVII with Form-XXVIII to an authority that is not the accident-area authority. That authority gives Form-XXIX notice to the accident-area authority and the State Government, then calls for Form-XXX with the accident details, the section 81 deposit and supporting papers before deciding.
Need help with a compensation claim?
The forms are simple, but errors in facts, wages or notice are what claims get tested on. Our legal consultation team can help you review the application, certificate and supporting documents before filing or replying.
Key takeaways
- Form-XXVII: application in duplicate; Form-XXVIII: applicant's accuracy certificate.
- Form-XXIX: notice to the authority of the accident area and the State Government before processing elsewhere.
- Form-XXX: detailed accident report with records, money and original documents.
- The rules state no fee and no separate time limit for these forms.
- State-sphere cases follow State rules.
Read next
- Rules 57 to 59: interest, notice and claim for compensation
- Rules 60 to 62: transfer of matters
- Sections 93 to 95: form of application and powers of the competent authority
- Workmen compensation vs ESI: which applies
Disclaimer: Based on the Code on Social Security, 2020 (as enacted) and, where noted, the Code on Social Security (Central) Rules, 2026 (G.S.R. 344(E), 8 May 2026), as on 30 September 2026. The Code is in force from 21 November 2025; some provisions may be notified later, and State Governments make their own rules for establishments where the State is the appropriate Government. Verify the current position before acting.