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    India-Form F Nomination 2017

    Uploaded by

    Preethi Ravindran

    Copyright:

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

    India-Form F Nomination 2017

    Uploaded by

    Preethi Ravindran
    14 views3 pages

    Original Title

    India-Form f Nomination 2017

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    14 views3 pages

    India-Form F Nomination 2017

    Uploaded by

    Preethi Ravindran

    Copyright:

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

    FORM 'F' Employee ID: _ _

    See sub-rule (1) of Rule


    6

    Nomination

    To,
    Juniper Networks India Pvt.Ltd, Elnath- Exora Business Park, Survey #111/1 to 115/4, Wing A&B., Amane
    Belandur Khane village, Marathalli, Sarjapur outer ring road, Bangalore – 560103. Karnataka.

    Shri
    I, Shri/Shrimati/Ku Preethi Ravindran
    (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 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 Age of Proportion by which


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

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

    1. R Poongothai Mother 51 50%

    2. Ishan Mishra Spouse 30 50%

    3.
    4.

    Statement
    1. Name of employee in fullPreethi Ravindran
    2. SexFemale
    3. ReligionHindu
    4. Whether unmarried/married/widow/widowerMarried

    5. Department/Branch/Section where employed Juniper Networks India Private Limited


    6. Post held with Ticket No. or Serial No., if any
    7. Date of appointment19/09/2022

    8. Permanent address:
    VillageGurgaon ThanaGurgaon Sub-division
    Post Office122002 District StateHaryana

    Place:Gurgaon Signature/Thumb-impression of the Employee

    Date:23/09/2022

    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

    Date: ___________________________________
    Signature of the employer/Officer authorised
    Designation

    Name and address of the establishment or rubber stamp thereof.


    Juniper Networks India Pvt.Ltd Elnath- Exora Business Park,
    Survey #111/1 to 115/4, Wing A&B. Amane Belandur Khane
    village, Marathalli, Sarjapur outer ring road
    Bangalore – 560103. Karnataka

    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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