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    7-FORM - F Gratuity - Signed

    Uploaded by

    Shubham Rao
    The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payment in the event of the employee's death. The form collects information about the employee such as name, gender, religion, marital status, department, and permanent address. It also collects details of the nominated beneficiaries such as name, address, relationship to employee, age, and proportion of gratuity to be received. The form needs to be signed by the employee and witnesses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    7-FORM - F Gratuity - Signed

    Uploaded by

    Shubham Rao
    74 views2 pages
    The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payment in the event of the employee's death. The form collects information about the employee such as name, gender, religion, marital status, department, and permanent address. It also collects details of the nominated beneficiaries such as name, address, relationship to employee, age, and proportion of gratuity to be received. The form needs to be signed by the employee and witnesses.

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    7-FORM- F Gratuity_Signed

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    The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payment in the event of the employee's death. The form collects information about the employee such as name, gender, religion, marital status, department, and permanent address. It also collects details of the nominated beneficiaries such as name, address, relationship to employee, age, and proportion of gratuity to be received. The form needs to be signed by the employee and witnesses.

    Copyright:

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

    7-FORM - F Gratuity - Signed

    Uploaded by

    Shubham Rao
    The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payment in the event of the employee's death. The form collects information about the employee such as name, gender, religion, marital status, department, and permanent address. It also collects details of the nominated beneficiaries such as name, address, relationship to employee, age, and proportion of gratuity to be received. The form needs to be signed by the employee and witnesses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    FORM 'F'

    [See sub-rule (1) of rule 6]

    Nomination

    To ……………………………………………………………………………………………………………..

    [Give here name or description of the establishment with full address]

    I. Shri/ Smt. /Kumari ………………………………..…………. whose particulars are given in


    the statement below,
    [Name in full here]
    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 that 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 a/are 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 a 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.

    Nominee(s)

    Name in full with full Relationship with the Age of nominee Proportion by which
    address of nominee(s) employee the 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.

    Village ……………… Thana ……………… Sub-division ………………. Post Office ………………

    District ………………. State…………………

    Place Signature/Thumb impression


    Date of the employee

    Declaration by witnesses

    Nomination signed/thumb impressed before me.

    Name in full and full Signature of witnesses.


    address 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.
    Digitally
    DIPTI signed by
    Employer's Reference No., if any. WARMAN DIPTI
    WARMAN
    Signature of the employer/
    officer authorised

    Designation

    Date Name and address of the


    establishment or rubber stamp
    thereof.

    Acknowledgement by the employee

    Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the
    employer.

    Date Signature of the employee

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