FORM – B

(See Rule No. 31.0 ( i ) of the Rules)

NOMINATION

To,
The Secretary
Board of Trustee
NTPC Ltd.
Employees Gratuity Fund
NEW DELHI – 110 019.

Sir,

I, Shri / Smt / Kumari ___________________________________________

Employee No. ___________________ of __________________________(Name
of the Unit) hereby nominate the person(s, mentioned below to receive the gratuity
payable after my death and 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).
1. I hereby certify that the person(s) mentioned is / are a member(s) of my
family within the meaning of explanation - I of rules 32.0 of the Rules and
Regulations.
2. I hereby declare that, I have no family within the meaning of explanation to
Rules 32.0 of the Rules and Regulations.
3. a. My father / mother / parents is / are not dependent on me.
b. My husband’s father / mother / parent is / are not dependent on my
husband.
4. I have excluded my husband from the family by a notice dated the
____________ to the Secretary in terms of provision to Explanation I (ii) to
Rule 32.0 of the Rules and Regulations.
5. Nomination made therein invalidates my previous nominee(s) nomination.

NOMINATION(S)
Sr. Name in full with full address Relationship with Age of nominee Proportion by
No. of nominees(s) the employee which gratuity be
shared
1

Place :
Date :
Signature / Thumb Impression
of the Employee.
 :::2:::

DECLARATION BY WITNESSES Nomination

signed / thumb impressed before me.

Name and address in full of : Signature of Witnesses

1. 1.

2. 2.

Place : _______________________

Date : _______________________

CERTIFICATE BY THE CONTROLLING OFFICER

Certified that the particulars of the above nomination have been verified.

Signature of the Controlling

Officer

Place :
Date :

ACKNOWLEDGEMENT BY THE SECRETARY

The above nomination has been recorded.

Place :

Date: Signature of the Secretary

________________________________________________________________________________

Note : 1. Strike out the words and / or paragraphs not applicable.

2. Secretary will send the duplicate copy of this form duly acknowledged to the employee.
NTPC

FORM OF APPOINTTMENT OF BENEFICIARY / BENEFICIARIES

NTPC Ltd.

Unit ____________________

Dear Sir,

I, _______________________________________________, a member of the NTPC Ltd.,

Employee’s Group Insurance Scheme, hereby appoint in terms of the Rule headed APPOINTMENT
OF VENEFICIARY/BENEFICIARIES in the Rules governing the scheme my
_____________________(Relationship)
_________________________ name _____________________________ aged
years and whose address is
_______________________________________________________________
________________________________________________________________
as the person to be the beneficiary to whom the money payable under the scheme shall be paid in
the event to my death.

Signed at _______________ this ________ day of _____________ 200

Witnessessed by :

Signature: ______________________ ______________________

(Signature of Member)

Name: _________________________ _____________________

(Name of Member)

Address: ____________________ ____________________

(Employee Number)
_______________________________

_______________________________ _____________________
(Designation)

______________________
(Department)
 NTPC EMPLOYEES DEATH RELIEF SCHEME
NOMINATION FORM
(IN DUPLICATE)

1.0 Name of the Employees (Block Letters) :

2.0 Employee Number:

3.0 Designation / Department:

4.0 Date of Joining NTPC (on regular rolls):

5.0 Present Address:

6.0 Permanent Address:

7.0 Contact Phone Nos.:

8.0 Details of Family Members:

Sl Name of Family Member Age in Year Martial Status Relationship with

No. Employee
01
02
03
04
05

9.0 I declare that all particulars furnished by me are correct and true. My nomination of family
members to whom the benefit under the scheme will accrue is given below:

(Where more than one person is nominated, indicate the percentage of distribution of benefits
between the nominees).

Sl Name of Family Member Age in Year Relationship with % of Benefit

No. Employee
01
02
03
04
05

Date: Place:

Signature:
(Signature to be made on both sheets of Form I) Name:
Place of Posting:

_____________________________________________________________________
To, Head of H. R., NTPC Project / Station / Unit

CC, Head of F&A, Project / Station / Unit.

 PTF-03 (RO)
EMP. NO. _____________

DECLARATION-CUM-NOMINATION FORM FOR NTPC LTD.

SELF CONTRIBUTORY SUPERANNUATION
BENEFIT (PENSION) TRUST.
(Form to by filled in Triplicate)

I, Shri / Smt / Kumari_______________________ of__________________________ (name of the

Office / Region) hereby agree to be a Member of the NTPC Ltd. Self Contributory Superannuation Benefit (Pension) Scheme' and
nominate the person mentioned below to receive "Pension" under the relevant provisions of the Scheme in the event of my
premature death in

service:-
NAME & ADDRESS OF THE AGE AND DATE OF BIRTH RELATIONSHIP WITH THE
FAMILY MEMBER ( attach Birth Certificate ) MEMBER

Place __________________
(Signature of the Member)
Date ___________________ Name of the Member

Witness: Designation
_______________
Department

1.
Witness:

2.

FOR USE IN PERSONNEL DEPARTMENT

Nomination form verified & found to be correct and kept in record.

(Sign, of Personnel deptt. Executive)

(Name & Designation with Seal)
CC:
1. Individual
2. Secretary. Pension Trust

Instructions for filling up Nomination:-

1. Nominee (Beneficiary) should be spouse in case of married Member and in absence of spouse his/her
Children.
2. In case of Member being unmarried or having no surviving dependent person as mentioned above, his/her
dependent parents.
3. In case none of the parents are surviving, then any one of dependent brother/sister Nomination in
deviation of above will not be accepted.
 Form 2 (Revised)
NOMINATION AND DECLARATION FORM FOR UNEXEMPTED/
EXEMPTED ESTABLISHMENTS

Declaration and Nomination Form under the Employees’ Provident Funds and
Employees’ Pension Scheme

(Paragraphs 33 & 61 (1) of the Employees Provident Fund Scheme, 1952 and Paragraph 18 of the Employees’ Pension scheme, 1995)

1. Name (in Block letters) :

2. Father’s/Husband’s Name :

3. Date of Birth :

4. Sex :

5. Marital Status :

6. Account No. :

7. Address Permanent :

Temporary :

8. Date of joining :

PART – A (EPF)
I hereby nominate the person(s) /cancel the nomination made by me previously and nominate the person(s) mentioned
below to receive the amount standing to my credit in the Employees’ Provident Fund in the event of my death :

Name of
nominee/ Address Nominee’s relation- Date of Total amount of share of If the nominee is a minor,
nominees ship with the member Birth Accumulations in Provi- name & relationship & address
dent Fund to be paid to of the guardian who may
each nominee receive the amount during the
minority of nominee

1 2 3 4 5 6

1. * Certified that I have no family as defined in para 2(g) of the Employees’ Provident Fund Scheme, 1952 and
should I acquire a Family hereafter, the above nomination should be deemed as cancelled.

2. * Certified that my father/mother is/are dependent upon me.

Signature or thumb impression of the subscriber

*Strike out whichever is not applicable.

 Part B (EPS) (Para 18)
I hereby furnish below particulars of the members of my family who would be eligible to receive widow/children pension in the event of my death.

S.No. Name of the family Address Date of Birth Relationship with the member
member

1 2 3 4 5

3. Certified that I have no family, as defined in para 2(vii) of Employees’ Pension Scheme, 1995 and should I acquire a
family hereafter I shall furnish particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension (admissible under para 16 2(a)(i) and (ii)
in the event of my death without leaving any eligible family member for receiving Pension.

Name and Address of the Nominee Date of Birth Relationship with the member

1 2 3

1.

2.

3.

4.

Date :

Signature or thumb impression of the subscriber

**Strike out whichever is not applicable.

CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smt./Kum._____________________________

______________________ employed in my establishment after he/she has read the entries/entries have been read over to him/her

by me and got confirmed by him/her.

Place : ________________

Signature of the employer or other

Authoried Officers of the Establishment.

Designation
Dated the : ____________________

Name & Address of the Factory/

Establishment or Rubber Stamp Thereon
 GUIDANCE FOR FILLING THE FORM No - 2

Employee’s Provident Fund Scheme, 1952:-

(EPF)
Para 33 :- Declaration by persons already employed at the time of institution of the fund :-

Every person who is required or entitled to become a member of the Fund shall be asked forthwith by his employer to
furnish and shall, on such demand, furnish to him, for communication to the Commissioner, particulars concerning
himself and his nominee required for the declaration form in Form 2. Such employer shall enter the particulars in the
declaration form and obtain the signature or thumb impression of the person concerned.

Para 61 : Nomination

2 Each member shall make in his declaration in Form 2, a nomination conferring the right to receive the amount that
may stand to his credit in the Fund in the event of his death before the amount standing to his credit has become
payable, or where the amount has become payable before payment has been made.
3 A member may in this nomination distribute the amount that may stand to his credit in the Fund amongst his
nominees at his own discretion.
4 If a member has a family at the time of making a nomination, the nomination shall be in favour of one or more
persons belonging to his family. Any nomination made by such member in favour of a person not belonging to his
family shall be invalid.
Provided that a fresh nomination shall be made by the member on his marriage and any nomination made before
such marriage shall be deemed to be invalid.
5 If at the time of making a nomination the member has no family, the nomination may be in favour of any person or
persons but if the member subsequently acquires a family, such nomination shall forthwith be deemed to be invalid
and the member shall make a fresh nomination in favour of one or more persons belonging to his family.
4A Where the nomination is wholly or partly in favour of a minor, the member may, for the purposes of this scheme
appoint a major person of his family, as defined in clause (g) of paragraph 2, to be the guardian of the minor
nominee in the event of the member predeceasing the nominee and the guardian so appointed.
Provided that where there is no major person in the family, the member may, at his discretion, appoint any other
person to be a guardian of the minor nominee.
5. A nomination made under sub-paragraph(1) may at any time be modified by a member after giving a written notice
of his intention of doing so in form 2. If the nominee predeceases the member, the interest of the nominee shall
revert to the member who may make a fresh nomination in respect of such interest.
6. A nomination or its modification shall take effect to the extent that it is valid on the date on which it is received by
the commissioner.
Para 2(g) : Family Means :-
(i) in the case of a male member, his wife, his children, whether married or unmarried, his
dependent parents and his deceased son’s widow and children;
Provided that if a member proves that his wife has ceased, under the personal law
governing him or the customary law of the community to which the spouses belong, to be
entitled to maintenance she shall no longer be deemed to be a part of the member’s family
for the purpose of this scheme, unless the member subsequently intimates by express
notice in writing to the commissioner that she shall continue to be so regarded; and
(ii) In the case of a female member, her husband, her children, whether married or
unmarried, her dependent parents, her husband’s, dependent parents, her deceased
sons’s widow and children;
Provided that if a member by notice in writing to the commissioner expresses her desire to
exclude her husband from the family, the husband and his dependent parents shall no
longer be deemed to be a part of the member’s family for the purpose of this scheme, unless
the member subsequently cancels in writing any such notice.
Explanation :- In either of the above two cases, if the child of a member [or as the case may
be, the child of a deceased son of the member ] has been adopted by another person and if,
under the personal law of the adopter, adoption is legally recognised, such a child shall be
considered as excluded from the family of the member.
EMPLOYEES PENSION SCHEME, 1995
(EPS)
Para 18 : Particulars to be supplied by the Employees already employed at the time of
commencement of the Employees Pension Scheme.
Every person who is entitled to become a member of the Employees Pension Fund shall be asked
forthwith by his employer to furnish and that person shall, on such demand, furnish to him for
communication to the Commissioner particulars concerning himself and his family in the form
prescribed by the Central Provident Fund Commissioner.

Para 2(vii) :- Family means :-

(i) Wife in the case of male member of the Employees’ Pension Fund;
(ii) Husband in the case of a female member of the Employees’ Pension fund;and
(iii) Sons and daughters of a member of the Employees Pension fund;
Explanation – The expression “Sons” and “daughters” shall include children [ Legally adopted by the
member]
NOTE : Members can nominate a person to receive benefits under the Employees’ Pension Scheme
1995 where a member is unmarried or does not have any family. Such nominee shall be
paid pension equal to widow pension in case of death of member.