Gratuity Form

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FORM 'F'

See sub rule(1) of Rule 6


Gratuity Nomination Form


To:
TATA Consultancy Services Ltd.
9th Floor, Nirmal Building,
Nariman Point, Mumbai - 400021.

I, Bhutada, Ms. Bharati Rajaram 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) nominated is/are a member(s) of my family within the meaning of clause (h) of Section 2
of the Payment of Gratuity Act,1972. - NA
3.I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the said Act. - NA
4.(a) My father is not dependent on me. - NA
(b) My mother is not dependent on me. - NA
(c) My spouse's father is not dependent on my spouse. - NA
(d) My spouse's mother is not dependent on my spouse. - NA
5.I have excluded my husband from my family by a notice dated the __________ to the controlling authority in terms of the
provison to clause (h) of Section 2 of the said Act. - NA
6.Nomination made herein invalidates my previous nomination. - Yes

Nominee(s)
Sr.No Name in full with full Address of
Nominee(s)
Relationship
with the
Employee
Date of
Birth
Proportion
by which
Gratuity will
be shared
Name , Relationship and
Address of Guardian if Nominee
is minor
Statement
Full Name: Bhutada, Ms. Bharati Rajaram Employee Number:
Sex: Female Date of joining:
Marital Status: Department: Computer Consultancy
Religion:
Permanent Address: 13/11/1, Ramrajya, Awade Nagar,, Ichalkaranji, Maharashtra, India - 416115
Date:
Place: Signature of the Employee
Declaration by Witnesses
Nomination signed before me
Sr.No Name in full with full address of Witnesses Signature of Witnesses
1.
2.
Date: Place:
Certificate by the Employer
Certified that the particulars of the above nominations have been verified and recorded in this establishment
Office Seal Signature of the Employer/Trustee
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

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