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    Gratuity Nomination

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    NEW CITY
    : SOLD TO : SHIP TO:. Gift To: DEEPAK SAH DEEPAK SAH Customer Comments: room no 9316 hostel no 9 MANIT room no 9316 hostel no 9 MANIT BHOPALM.A.C.T. Bhopal - 462007 BHOPALM.A.C.T., Madhya Pradesh, India Bhopal Phone: 9755233173

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    Gratuity Nomination

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    NEW CITY
    47 views2 pages
    : SOLD TO : SHIP TO:. Gift To: DEEPAK SAH DEEPAK SAH Customer Comments: room no 9316 hostel no 9 MANIT room no 9316 hostel no 9 MANIT BHOPALM.A.C.T. Bhopal - 462007 BHOPALM.A.C.T., Madhya Pradesh, India Bhopal Phone: 9755233173

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    : SOLD TO : SHIP TO:. Gift To: DEEPAK SAH DEEPAK SAH Customer Comments: room no 9316 hostel no 9 MANIT room no 9316 hostel no 9 MANIT BHOPALM.A.C.T. Bhopal - 462007 BHOPALM.A.C.T., Madhya Pradesh, India Bhopal Phone: 9755233173

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views2 pages

    Gratuity Nomination

    Uploaded by

    NEW CITY
    : SOLD TO : SHIP TO:. Gift To: DEEPAK SAH DEEPAK SAH Customer Comments: room no 9316 hostel no 9 MANIT room no 9316 hostel no 9 MANIT BHOPALM.A.C.T. Bhopal - 462007 BHOPALM.A.C.T., Madhya Pradesh, India Bhopal Phone: 9755233173

    Copyright:

    © All Rights Reserved
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    of 2

    FORM-F

    NOMINATION

    1. I, Shri/Smt ./Kum (Name in full here).................................................................................. whose particulars are


    given in the statement below, hereby nominate the person(s) mentioned below to receive the gratuity payable
    after my death as also the gratuity standing to my credit in the event of my death before the amount has
    become payable, or having become payable has not been paid and direct that the said amount of gratuity shall
    be paid in proportion indicated against the name(s) of the nominee(s).

    2. I hereby certify that the person(s) mentioned is/are a member(s) of my family within the meaning of clause
    (h) of section 2 of the payment of Gratuity Act 1972.
    3. I hereby declare that I have no family within the meaning of clause (h) of section 2 of the said Act.
    4. (A) My father/mother/parents is/are not dependent on me.
    (B) My husband’s father/mother/parents is/are not dependent on my husband.
    5. I have excluded my husband from my family by notice dated the...................................................... to the
    controlling authority in terms of the proviso to clause (h) of section 2 of the said Act.
    6. Nomination made herein invalidates my previous nomination.

    NOMINATION(S)
    _________________________________________________________________________________________
    ___
    NAME IN FULL WITH RELATIONSHIP AGE OF PROPORATION
    FULL ADDRESS OF WITH THE NOMINEE BY WHICH THE
    NOMINEE(S) EMPLOYEE GRATUITY WILL
    BE SHARED
    _________________________________________________________________________________________
    ___

    1
    2
    3
    _________________________________________________________________________________________
    ___

    STATEMENT
    1 Name of employee in full _____________________________________
    2 Sex _____________________________________
    3 Religion _____________________________________
    4 Whether unmarried/ married/widow/widower __________________________________
    5 Department/branch/section where employed __________________________________
    6 Post held with ticket or serial no, if any __________________________________
    7 Date of appointment __________________________________
    8 Permanent address : ____________________________________________
    ____________________________________________
    ____________________________________________

    Place : ________________ SIGNATURE/THUMB IMPRESSION

    1
    Date : ________________ OF THE EMPLOYEE

    _________________________________________________________________________________________
    ___

    DECLARATION BY THE WITNESS


    Nomination signed/thumb impressed before me.
    Name in full and full address of Signature of witnesses

    1. 1

    2. 2

    Place : ________________
    Date : ________________
    _________________________________________________________________________________________
    ___

    CERTIFICATE BY THE EMPLOYER


    Certified that the particulars of the above nomination have been verified and recorded in this establishment.

    Employer’s reference no, if any Signature of the employer/officer authorized


    Designation
    Date __________
    _________________________________________________________________________________________
    ___

    ACKNOWLEDGMENT BY THE EMPLOYEE


    Received the duplicate copy of nomination in Form- ‘F’ filled by me and duly certified by the employer.

    Date ___________ Signature of the employee

    _________________________________________________________________________________________
    ___

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