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    Gratuity Form

    Uploaded by

    Nikhil Agarwal

    Copyright:

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

    Gratuity Form

    Uploaded by

    Nikhil Agarwal
    64 views3 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    64 views3 pages

    Gratuity Form

    Uploaded by

    Nikhil Agarwal

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Payment of Gratuity (Central) Rules

    FORM 'F'
    See sub-rule (1) of Rule 6

    Nomination

    To,
    (Give here name or description of the establishment with full address)
    PARAMVEER TOMAR (NEW DHEERWALI NEAR RAMLILA GROUND JWALAPUR HARIDWAR)

    I, Shri/Shrimati/Kumari ADHESH TOMAR


    (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 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/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 the controlling authority in terms of the to
    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 Age of Proportion by which


    address of nominee(s) the employee nominee the gratuity will be
    shared

    (1) (2) (3) (4)

    1. ADESH TOMAR FATHER 54 100%


    2.
    3.
    So
    on.
    Statement
    1. Name of employee in full PARAMVEER TOMAR
    2. Sex MALE
    3. Religion HINDU
    4. Whether unmarried/married/widow/widower UNMARRIED
    5. Department/Branch/Section where employed HARIDWAR
    6. Post held with Ticket No. or Serial No., if any
    7. Date of appointment 01/01/2024
    8. Permanent address:
    Village HAIDAR Thana BAGHAR Sub-division MUZAFFARNAGAR
    Post Office BAGHAR District MUZAFFARNAGAR State UTTER PRADESH

    Place: HARIDWAR
    Signature/Thumb-impression of the
    Employee
    Date: 23/04/2024

    Declaration by Witnesses

    Nomination signed/thumb-impressed before me


    Name in full and full address of witnesses. 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 authorised
    Designation

    Date: Name and address of the establishment or


    rubber stamp thereof.
    PARAMVEER TOMAR (NEW DHEERWALI NEAR RAMLILA GROUND JWALAPUR HARIDWAR)
    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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