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    Gratuity Form F

    Uploaded by

    Ravi Borravath
    1. The document is a nomination form for payment of gratuity under the Payment of Gratuity Act of 1972. 2. It contains fields for the employee to provide their name and address, nominate individuals from their family to receive gratuity payments in the event of death, and certify their family status. 3. The form requires signatures from the employee, witnesses, and employer to validate the nomination and record the particulars in the establishment.

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

    Gratuity Form F

    Uploaded by

    Ravi Borravath
    61 views2 pages
    1. The document is a nomination form for payment of gratuity under the Payment of Gratuity Act of 1972. 2. It contains fields for the employee to provide their name and address, nominate individuals from their family to receive gratuity payments in the event of death, and certify their family status. 3. The form requires signatures from the employee, witnesses, and employer to validate the nomination and record the particulars in the establishment.

    Original Description:

    Original Title

    Gratuity Form F (1)

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    1. The document is a nomination form for payment of gratuity under the Payment of Gratuity Act of 1972. 2. It contains fields for the employee to provide their name and address, nominate individuals from their family to receive gratuity payments in the event of death, and certify their family status. 3. The form requires signatures from the employee, witnesses, and employer to validate the nomination and record the particulars in the establishment.

    Copyright:

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

    Gratuity Form F

    Uploaded by

    Ravi Borravath
    1. The document is a nomination form for payment of gratuity under the Payment of Gratuity Act of 1972. 2. It contains fields for the employee to provide their name and address, nominate individuals from their family to receive gratuity payments in the event of death, and certify their family status. 3. The form requires signatures from the employee, witnesses, and employer to validate the nomination and record the particulars in the establishment.

    Copyright:

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

    PAYMENT OF GRATUITY ACT.

    [ SEE SUB-RULE (1) of Rule 6 ]


    NOMINATION
    To,
    …………………………………………………...
    …………………………………………………...

    [ I Give here name or description of the establishment with full address ]

    1. Shri/Shrimati……………………………………………………………………………….
    [Name in the here]

    Whose particulars are given in the statement below. 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 the 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 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 provision 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 the
    address of nominee(s) the employee nominee gratuity will be shared
    (1) (2) (3) (4)
    STATEMENT
    1. Name of the 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. Serial No. if any………………………………………………………
    7. Date of appointment……………………………………………………………………………….
    8. Permanent address………………………………………………………………………………..
    Village………………………………Thana……………………Sub Division……………………
    Post Office………………………….District…………………..State…………………………….
    Place-
    Signature/Thumb Impression
    Date……………. of the employee

    Declaration by witnesses
    Nomination signed/Thumb impressed before me
    Name in full and full address of witnesses

    signature of witnesses
    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 authorized


    Designation

    Name address of the establishment


    Date……………….. or rubber stamp there of

    Acknowledgment by the employee


    Received the duplicate of the nomination in Form ‘F’ Filled by me and duly certified by the
    employer.

    Date……………………

    Note: Strike out words/paragraph not applicable Signature of the employee

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