Form F Gratauity

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FORM – F

[See Sub-Rule (1) of


Rule 6] NOMINATION
T
o

Sorting Hat Technologies Pvt Ltd


Maruti Infotech Centre 3rd Floor A
Block Domlur Koramangala Inner Ring Road
Bangalore - 560071
Laxman Singh
I Shri/smt./Kumari ............................................ 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).

⦁ 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.

⦁ I hereby declare that I have no family within the meaning of clause (h) of section 2
of thesaid act.

⦁ (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.

⦁ I have excluded my husband from my family by a notice dated the to the Controlling Aut

⦁ 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. Gali number 36 Mohan
Garden,Uttam Nagar, FATHER 48
New Delhi 110056 100%

2.

3.

4.

So On
Statement

⦁ Name of employee in full : Gaurav Singh

⦁ Sex: Male
⦁ Religion : Hindu

1
⦁ Whether unmarried/married/widow/widower : Unmarried

⦁ Department / Branch/Section where employed : Sales


⦁ Post held with Ticket or Serial No.,if any :
⦁ Date of appointment : 25/03/2024
⦁ Permanent address : 1283,Pushp Vihar,Sec7 MB.Road Saket
New Delhi 110017
New Delhi
Village New Delhi Thana Saket Sub-division

Post office Pushpa Bhawan District south Delhi State DELHI

Place : NOIDA Signature / Thumb-impression


Date : 23/03/2024 of the employee.
Declaration by witnesses
Nomination signed / thumb-impressed before me.

Name in full and full Signature of


witnesses address of witnesses

1. Laxman Singh 1.

2. 2.

Place: Delhi
Date : 23/03/2024

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. for Sorting Hat Technologies Pvt Ltd

Sorting Hat Technologies Pvt Ltd


Maruti Infotech Centre 3rd Floor A
Block Domlur Koramangala Inner Ring Road
Bangalore - 560071
Authorized Signatory
Signature of the employer / officer
authorised Designation

Name & Address of the


establishment or Rubber-stamp
thereof
Acknowledgment by the
employee

Received the duplicate copy of nomination in Form `F’ filed by me and duly certified by
the employer.

2
Date: 23/03/2024 Signature of the employee

Note : Strike out the words/paragraphs not applicable.

Definition for Family

⦁ “Family” in relation to an employee, shall be deemed to consist of –

⦁ in the case of a male employee, himself, his wife, his children, whether married or
un married, his dependent parents 1 [and the dependent parents of his wife and the
widow] and children of his predeceased son, if any.

(ii) in the case of a female employee, herself husband, her children, whether married, or
unmarried, her dependent parents and the dependent parents of her husband and the
widow and children of her predeceased son, if any:
[1. Substituted for the words “and the widow” by Act No. 22 of 1987, s.2(ii)(a), w.e.f.
1-10-1978]

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