Form F Gratuity Nomination - Filled

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Payment of Gratuity (Central) Rules

FORM 'F'
See sub-rule (1) of Rule 6

Nomination

To, INNOMIDS SOFRWARE PRIVATE LIMITED


(Give here name or description of the establishment with full address)
Kala Jyothi Building, Survey No 185, Kondapur Village,
Serilingampally, Hyderabad, Telangana - 500084.

I, Shri/Shrimati/Kumari Sunil Manohar Gunturi


(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 Not Applicable to
the controlling authority in terms of the proviso 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


address of nominee(s) the employee nominee the gratuity will be
shared

(1) (2) (3) (4)

1. Lakshmi Naga Sarvani Gunturi Wife 35 100%


2.
3.
So
on.
Statement
1. Name of employee in full Sunil Manohar Gunturi

2. Sex Male
3. Religion Hindu
4. Whether unmarried/married/widow/widower Married
5. Department/Branch/Section where employed QA Department
6. Post held with Ticket No. or Serial No., if any Not Applicable
7. Date of appointment 29-Aug-2022
8. Permanent address:
Village Hyderabad Thana Miyapur Sub-division Miyapur
Post Office Matrusri Nagar District Ranga Reddy State Telangana

Place: Hyderabad
Signature/Thumb-impression of the
Employee
Date: 20-Oct-2022

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: Signature of the Employee

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