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    Form 'F': Nomination

    Uploaded by

    mohan
    This document contains a nomination form for payment of gratuity under the Payment of Gratuity Act. [1] The employee, Shri/Shrimati/Kumari [name], nominates the person(s) listed with their name, address, relationship to employee, age, and proportion of gratuity to receive payment of any gratuity owed in the event of the employee's death. [2] The employee certifies that the nominee(s) are member(s) of their family as defined by the Act. Or that they have no family. Or have excluded their spouse from consideration. [3] Witnesses sign to verify the nomination and the employer certifies

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    © All Rights Reserved
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    Form 'F': Nomination

    Uploaded by

    mohan
    43 views2 pages
    This document contains a nomination form for payment of gratuity under the Payment of Gratuity Act. [1] The employee, Shri/Shrimati/Kumari [name], nominates the person(s) listed with their name, address, relationship to employee, age, and proportion of gratuity to receive payment of any gratuity owed in the event of the employee's death. [2] The employee certifies that the nominee(s) are member(s) of their family as defined by the Act. Or that they have no family. Or have excluded their spouse from consideration. [3] Witnesses sign to verify the nomination and the employer certifies

    Original Description:

    Gratutity form

    Original Title

    Form F

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    This document contains a nomination form for payment of gratuity under the Payment of Gratuity Act. [1] The employee, Shri/Shrimati/Kumari [name], nominates the person(s) listed with their name, address, relationship to employee, age, and proportion of gratuity to receive payment of any gratuity owed in the event of the employee's death. [2] The employee certifies that the nominee(s) are member(s) of their family as defined by the Act. Or that they have no family. Or have excluded their spouse from consideration. [3] Witnesses sign to verify the nomination and the employer certifies

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    43 views2 pages

    Form 'F': Nomination

    Uploaded by

    mohan
    This document contains a nomination form for payment of gratuity under the Payment of Gratuity Act. [1] The employee, Shri/Shrimati/Kumari [name], nominates the person(s) listed with their name, address, relationship to employee, age, and proportion of gratuity to receive payment of any gratuity owed in the event of the employee's death. [2] The employee certifies that the nominee(s) are member(s) of their family as defined by the Act. Or that they have no family. Or have excluded their spouse from consideration. [3] Witnesses sign to verify the nomination and the employer certifies

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    FORM 'F'

    PAYMENT OF GRATUITY ACT


    See sub-rule (1) of Rule 6

    Nomination

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

    I, Shri/Shrimati/Kumari
    (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 proviso to clause (h) of Section 2 of the said Act.

    to

    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)

    1.
    2.
    3.
    So
    on.

    (2)

    (3)

    (4)

    the

    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:
    Signature/Thumb-impression of the Employee
    Date:

    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.

    Acknowledgement by the Employee


    Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.
    Date:

    Note.Strike out the words/paragraphs not applicable.

    Signature of the Employee

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