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    Wa0078.

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    Ankush singh
    This document contains a nomination form for payment of gratuity. 1) The employee, Ankush Singh, is nominating his father Ajay Singh to receive any gratuity payment owed in the event of his death. 2) Ankush provides his personal details like name, date of birth, address to identify himself. 3) The nomination must be signed by witnesses and certified by the employer to be valid.

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    © All Rights Reserved
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    Wa0078.

    Uploaded by

    Ankush singh
    18 views2 pages
    This document contains a nomination form for payment of gratuity. 1) The employee, Ankush Singh, is nominating his father Ajay Singh to receive any gratuity payment owed in the event of his death. 2) Ankush provides his personal details like name, date of birth, address to identify himself. 3) The nomination must be signed by witnesses and certified by the employer to be valid.

    Original Description:

    Kajajansnkansnsn

    Original Title

    DOC-20240222-WA0078.

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    This document contains a nomination form for payment of gratuity. 1) The employee, Ankush Singh, is nominating his father Ajay Singh to receive any gratuity payment owed in the event of his death. 2) Ankush provides his personal details like name, date of birth, address to identify himself. 3) The nomination must be signed by witnesses and certified by the employer to be valid.

    Copyright:

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

    Wa0078.

    Uploaded by

    Ankush singh
    This document contains a nomination form for payment of gratuity. 1) The employee, Ankush Singh, is nominating his father Ajay Singh to receive any gratuity payment owed in the event of his death. 2) Ankush provides his personal details like name, date of birth, address to identify himself. 3) The nomination must be signed by witnesses and certified by the employer to be valid.

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    © All Rights Reserved
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    FORM F

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


    PAYMENT OF GRATUITY NOMINATION

    To
    Head HRD

    1. I,below,
    Shri/ Shrimati/ Kumari Aaush whose particulars are given in the statement
    hereby nominate the person(s) mentiohed below to receive the gratuity payable after death as also the
    gratuity standing to my credit in the even of my death before the amount has become payable, or having become
    payable has nor 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. Ihere by certify that the person(s) mentioned is/are my wife/childre/lawfully adopted child/dependant
    parents/husband.
    3. I hereby declare that | have no family and should I acquire family hereafter the appointment of
    Beneficiary/Nominee should be deemed as cancelled.
    4. a) My father/mother/parents/sister(s)/ minor brother(s) is/are not dependant on me.
    b) My husband's father/mother/parents is/are not dependent on my husband. to the controlling authority in terms
    1. Ihave excluded my husband from my family by a notice dated
    of the proviso to clause (h) of section 2 of the said Act.
    2. Nomination made herein invalidates my previous nomination.
    Nominee(s)
    Relationship with Age of Nominee/s Proportion of which the
    S. No.Name in full with full gratuity (total benefits) will be
    address of Nominee/ the employee Beneficiary/ies
    shared by each Nominee
    Beneficiary/ies
    Beneficiary

    Ajg singh (oo.


    1.
    |A-bolA kyichan fathes
    2. Vinas ew delhi-l) oo&e

    3.

    4.

    I give below the particulars about myself:


    1 Full Name: Ankush Singh
    2 Sex. male
    3 Religion Hlndu
    4 Father's Name:
    Husband's Name:
    Ajay Singh
    5
    (For married women only)
    Martial Status: Single
    (Whether married, unmarried, widow or widower)
    Department/Branch/Section where employed
    8 Post held with ticket or SerialNo. if any
    9. Date of birth: -03-2002
    Date of appointment: 22-02-2024
    10.
    11. Permanent Address: A-bolA Rishan Vihar New dehi_loo&6

    PlaceDelhi Signature/ thkmb-impression


    Date 22-02 2024. of the employee
    DECLARATION BY WITNESSES

    Nomination signed/thumb-impressed before me.

    Address Signature
    S.No. Name

    1
    H-16 Rs han ihr
    New dal ) -)1096
    2 H-72 kxithan Vihay
    Riya. New delhi lob &6

    Place: pelh
    Date:
    22-02-2024

    CERTIFICATE BY THE EMPLOYER


    been signed by Shri/Shrimati
    Certified that the above appointment of Beneficiary Nominee has been
    before me after he/she has read the entries, the entries have
    Beneficiary/Nominee is recorded under the Scheme on
    read to him/her by me and that the said appointment of

    Signature of employer/
    Employer's reference No., if any
    Officer authorized Designation
    Date:

    NOTE:

    Beneficiary/Nominee, the Nomination


    1 Where an Employee Member has a family at the time of appointing a
    Employee in favour of any
    should be made in favour of Member of his family only. Any Nomination made by such
    other persons not belonging to his family shall be invalid. time, after giving a
    2 An Appointment of Beneficiary/Nominee made by the Member may be changed at any
    written notice to the Employer of his intention to do so. If the Nominee predeceases the Member
    his estate.
    (Employee), the interest of the Nominee shall revert to the member (Employee) or
    from time to time shall take effect to the
    3 The appointment of Beneficiary/Nominee or any change thereof made
    Employer.
    extent to the extent it is valid on the date on which it is received by the
    be deemed to consist of:
    4 For the purpose of the Scheme, "Family", in relation to employee, shall dependent parents
    ()ln case of a male employee, himself, his wife, his children, whether or unmarried, her if any.
    predeceased son,
    and the dependent parents of herhusband and the widow and children of her
    married or unmarried, her
    (ii)lncase of a female employee, herself, her husband, her children whether
    widow and children of her
    dependent parents and the dependent parents of her husband and the
    predeceased son, if any.
    within ninety days of acquiring a
    1 An employee who has no family at the time of making a nomination shall,
    family, submit in the manner specified in sub rule (1), a fresh nomination, as
    required under sub section (4) of
    Section 6, in duplicate in Form'G' to the employer.

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