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    Form F

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    amitkagrawal83
    1. This document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. The employee provides their personal details and nominates up to four beneficiaries, including each beneficiary's name, address, relationship to the employee, age, and proportion of gratuity to be received. 3. The employee certifies that the nominated beneficiaries are members of their family as defined by law, and the nomination invalidates any previous nominations filed. Witnesses and the employer also certify parts of the form.

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    Form F

    Uploaded by

    amitkagrawal83
    168 views1 page
    1. This document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. The employee provides their personal details and nominates up to four beneficiaries, including each beneficiary's name, address, relationship to the employee, age, and proportion of gratuity to be received. 3. The employee certifies that the nominated beneficiaries are members of their family as defined by law, and the nomination invalidates any previous nominations filed. Witnesses and the employer also certify parts of the form.

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    1. This document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. The employee provides their personal details and nominates up to four beneficiaries, including each beneficiary's name, address, relationship to the employee, age, and proportion of gratuity to be received. 3. The employee certifies that the nominated beneficiaries are members of their family as defined by law, and the nomination invalidates any previous nominations filed. Witnesses and the employer also certify parts of the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    168 views1 page

    Form F

    Uploaded by

    amitkagrawal83
    1. This document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. The employee provides their personal details and nominates up to four beneficiaries, including each beneficiary's name, address, relationship to the employee, age, and proportion of gratuity to be received. 3. The employee certifies that the nominated beneficiaries are members of their family as defined by law, and the nomination invalidates any previous nominations filed. Witnesses and the employer also certify parts of the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    FORM 'F'

    See sub-rule (1) of Rule 6

    Nomination
    To,

    SHRMER HR & STAFFING SOLUTIONS


    PVT. LTD.
    SB 31, 2nd Floor, High Street Cum
    Highland Corporate Centre,
    Kapurbawadi, Thane - 400 607.

    (Give here name or description of the establishment with full address)

    1 I, Shri./Smt./Kumari

    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 that amount has become payable, or having become payable has not
    been paid & 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 a notice dated …………… to the Controlling
    Authority in terms of the provision 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 Age of Proportion by which the
    Address of Nominee(s) the employee Nominee Gratuity will be shared
    1
    2
    3
    4
    and so on.

    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 No or Serial No, if any
    7 Date of Appointment
    8 Permanent Address Village : Thana : Sub-Division :
    Post office : District : State :

    Place :
    Date :
    Signature/Thumb Impression of the Employee

    Declaration by Witnesses

    Nomination signed/thumb-impressed before me

    Name in full and full Signature of Witness


    Address of witnesses

    1. 1.

    2. 2.

    Place :
    Date :

    Certificate by the Employer

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

    Employer's Signature of the Employer/Officer Authorised


    Reference No, if any Designation :

    Date : Name and Address of the Establishment


    or Rubber stamp thereof.

    SHRMER HR & STAFFING SOLUTIONS PVT. LTD.


    SB 31, 2nd Floor, High Street Cum Highland Corporate
    Centre, Kapurbawadi, Thane - 400 607.

    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


    Note : Strike out the words/paragraphs not applicable.

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