Form 'F': Nomination
Form 'F': Nomination
Form 'F': Nomination
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
to
Nominee(s)
Relationship with
Age of
Proportion by which
address of nominee(s)
the employee
nominee
(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: