Form ‘F’ Nomination under Payment of Gratuity Act, 1972 [Rule 6(1)] The Trustees Accenture Employees Group Gratuity cum Life Assurance scheme.
TARUN Father Father: KUMAR T Name Name/ Sur Husband T N RAJU Name Name Sex Employee MALE Code -1 Religion Martial HINDU Status single Date of 20/12/2003 Permanent GOREGAON EET BHATTI Birth Address: Date of Joining 01/07/2024 I 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 names(s) of the nominee(s). Sr.No Name in Full with full address of Relationship with the Age of Proportion by Nominee/s Employee Nominee/s which Gratuity will be shared 1 LAXMI 45 100 MOTHER
2. I have no family and should I acquire a family hereafter, the above nominations shall be deemed to be cancelled and fresh nominations in favor of one or more of my family members shall be provided by me. 3. 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. 4. I hereby declare that I have no family within the meaning of clause (h) of section 2 of the said Act. 5. (a). I hereby certify that my father/mother/parents is/are not dependent on me. (b). My husband's father/mother/parents is/are not dependent on my husband. 6. I have excluded my husband from my family by a notice dated ………to the controlling authority in terms of the proviso to clause (h) of section 2 of the said Act. 7. Nomination made herein invalidates my previous nomination. • Strike out the words/paragraphs not applicable.. 01 day of _____ Dated this _____ 2024 at__________ 07 _____ MUMBAI Declaration By Witnesses Nomination signed/thumb impressed before me.
Name in full and full address of witnesses Signature of witnesses
Signature of Employee CERTIFICATE BY THE EMPLOYER Certified that the particulars of the above nomination & declaration have been verified and recorded in the establishment. Place: Signature of the Trustee/Authorised person Date: For Self and co-Trustees of Accenture ______________________ Employees Group Gratuity cum Life Assurance scheme. ACKNOWLEDGMENT BY THE EMPLOYEE Received the duplicate copy of Nomination in Form F filed by me and duly certified by the Employer. Place:
Date: Signature of Employee
______________________ GF_ -1 ....,,
ON_ -1
Nomination form for other Benefits
Accenture Solutions Pvt. Ltd, Plant 3, Godrej & Boyce Complex, Pirojshanagar, Vikhroli (West), Mumbai - 400 079. Name Father Name/ Husband Name
I Tarun Kumar T Father: T N RAJU Employee I Date of birth Date of Joining 20/12/2003 01/07/2024 Code -1 Gender Male Marital Status single
I hereby nominate the person(s) mentioned below to receive all my dues after my death in proportion indicated against the name(s) of the nominee(s).
Group Personal accident
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
F1,1II & Fina! payments {ie Ynclaimed reimbYrsement, Ynpaid salary, leave etc) Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
Employees Deposit Link Insurance
Sr.No .Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
American Express Corporate Credit Card
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100 ....,,
Group Mediclaim Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
Future Service Liability
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
Overseas Travel Insurance
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
Group Term Life Insurance
Sr.No Full Name of the Nominee Relationship with Age of the Share of compensation Employee Nominee/s to be paid to nominee(%) 1 Laxmi Mother 45 100
Declaration by Witnesses: Name Name Employee code Employee code Signature Signature Place Place Dated Dated
Employee Code -1 I Location Mumbai Employee Signature Date 01/07/2024
Certificate by the Employer:
Certified that the above nomination as declared by the employee is taken on record.
Place Mumbai Date Signature of Authorized Signatory 01/07/2024 For Accenture Solutions Pvt. Ltd ON_ -1
