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    Gratuity Nominee Form - Form (F)

    Uploaded by

    Laxminarayan
    This document is a nomination form for an employee to designate beneficiaries to receive any gratuity payments due after the employee's death. [1] The employee provides their name and nominates specific individuals as beneficiaries, listing each nominee's name, address, relationship to the employee, age, and percentage of gratuity to be received. [2] The employee certifies that the nominated beneficiaries are family members as defined by law. [3] The form requires signatures from the employee and witnesses for the fresh nomination and provides spaces for employer verification and employee acknowledgment of the nomination.

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

    Gratuity Nominee Form - Form (F)

    Uploaded by

    Laxminarayan
    235 views2 pages
    This document is a nomination form for an employee to designate beneficiaries to receive any gratuity payments due after the employee's death. [1] The employee provides their name and nominates specific individuals as beneficiaries, listing each nominee's name, address, relationship to the employee, age, and percentage of gratuity to be received. [2] The employee certifies that the nominated beneficiaries are family members as defined by law. [3] The form requires signatures from the employee and witnesses for the fresh nomination and provides spaces for employer verification and employee acknowledgment of the nomination.

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    Original Title

    Gratuity Nominee Form_Form (F)

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    This document is a nomination form for an employee to designate beneficiaries to receive any gratuity payments due after the employee's death. [1] The employee provides their name and nominates specific individuals as beneficiaries, listing each nominee's name, address, relationship to the employee, age, and percentage of gratuity to be received. [2] The employee certifies that the nominated beneficiaries are family members as defined by law. [3] The form requires signatures from the employee and witnesses for the fresh nomination and provides spaces for employer verification and employee acknowledgment of the nomination.

    Copyright:

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

    Gratuity Nominee Form - Form (F)

    Uploaded by

    Laxminarayan
    This document is a nomination form for an employee to designate beneficiaries to receive any gratuity payments due after the employee's death. [1] The employee provides their name and nominates specific individuals as beneficiaries, listing each nominee's name, address, relationship to the employee, age, and percentage of gratuity to be received. [2] The employee certifies that the nominated beneficiaries are family members as defined by law. [3] The form requires signatures from the employee and witnesses for the fresh nomination and provides spaces for employer verification and employee acknowledgment of the nomination.

    Copyright:

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

    [See sub-rule (1) of rule 6]


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

    1. 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 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 member(s) of my family within the meaning
    of Cl. (h) of Sec. 2 of the Payment of Gratuity Act, 1972.

    3. I hereby declare that I have no family within the meaning of Cl. (h) of Sec.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 proviso to Cl. (h) of Sec.2 of the said Act.

    6. Nomination made herein invalidates my previous nomination.

    NOMINEE(S)
    Name in full with Relationship with Age of nominee Proportion by
    full address of the employee which the gratuity
    nominee(s) will be shared
    1 2 3 4
    1.
    2.
    3.
    4
    and so on.

    Note: strike out the words and paragraphs not applicable.


    STATEMENT
    1.Name of employee in full :
    2. Gender :
    3. Religion :
    4. Whether unmarried/married/widow/widower :
    5. Department/Branch/Section where employed :
    6. Post held with Ticket or Serial. No., if any :
    7. Date of appointment :
    8. Permanent address :

    Village……………..Thana…………….sub-division………………….
    Post office…………...District…………………State…………………..

    Signature/Thumb-impression
    of the employee.
    Place………………
    Date……………….

    DECLARATION BY WITNESSES
    Fresh nomination signed/thumb-impressed before me.

    Name in full and full address of: Signature of witnesses:


    1……………….. 1…………………….
    2……………….. 2……………………..

    Place………………..
    Date………………..

    CERTIFICATE BY THE EMPLOYER

    Certificate that the particulars of the above nomination have been verified and recorded in this
    establishment.

    Employer’s Reference No., if any.


    Date……………..
    Signature of the employer/
    Officer authorized.
    Designation.
    Name and 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.

    Date………………. Signature of the employee.

    Note: strike out the words and paragraphs not applicable.

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