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    Gratuity Form

    Uploaded by

    Alok Hegde
    The document is a nomination form under the Payment of Gratuity (Central) Rules, 1972 for an employee to nominate beneficiaries to receive any gratuity payments due in the event of the employee's death. It collects information about the employee such as name, address, family status, and employment details, and allows the employee to nominate one or more family members to receive a specified proportion of gratuity. Employers are required to verify and record the nomination details.

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

    Gratuity Form

    Uploaded by

    Alok Hegde
    208 views2 pages
    The document is a nomination form under the Payment of Gratuity (Central) Rules, 1972 for an employee to nominate beneficiaries to receive any gratuity payments due in the event of the employee's death. It collects information about the employee such as name, address, family status, and employment details, and allows the employee to nominate one or more family members to receive a specified proportion of gratuity. Employers are required to verify and record the nomination details.

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    The document is a nomination form under the Payment of Gratuity (Central) Rules, 1972 for an employee to nominate beneficiaries to receive any gratuity payments due in the event of the employee's death. It collects information about the employee such as name, address, family status, and employment details, and allows the employee to nominate one or more family members to receive a specified proportion of gratuity. Employers are required to verify and record the nomination details.

    Copyright:

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

    Gratuity Form

    Uploaded by

    Alok Hegde
    The document is a nomination form under the Payment of Gratuity (Central) Rules, 1972 for an employee to nominate beneficiaries to receive any gratuity payments due in the event of the employee's death. It collects information about the employee such as name, address, family status, and employment details, and allows the employee to nominate one or more family members to receive a specified proportion of gratuity. Employers are required to verify and record the nomination details.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    The Payment of Gratuity (Central) Rules, 1972

    FORM 'F'
    [See sub-rule (1) of rule 6]
    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 a/are 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 dependant on me.


    (b) My husband's father/mother/parents is/are not dependant on my husband

    5. I have excluded my husband from my family by a notice dated the……………………………to the


    NOMINEE(S) 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.

    Name in full with Proportion


    Relationship
    full address of Age of nominee by which the
    With the Employee
    nominee(s) gratuity will be shared

    12
    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 or Serial No., if any.

    7. Date of appointment.

    8. Permanent address

    District …………………………………... State……………………………………

    Place : Signature / Thumb-impression

    Date : of the employee:

    Declaration by witnesses

    Fresh nomination signed / thumb-impressed before me.

    Name in full and full Signature of witnesses


    address 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

    Authorised Signatory
    Name & Address of the establishment /
    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/paragraphs not applicable.


    Note: Please retain with you for any change in marital status at a later date

    13

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