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    Form-F-Nomination-Gratuity Sample

    Uploaded by

    VENKATESAN B
    The document is a nomination form for an employee named Shri/Shrimati/Kumari to nominate recipients for payment of gratuity in the event of their death. The form collects information about the employee such as name, department, date of appointment, and nomination of family members to receive gratuity payment. Witnesses are also required to sign the form to validate the nomination.

    Copyright:

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

    Form-F-Nomination-Gratuity Sample

    Uploaded by

    VENKATESAN B
    408 views3 pages
    The document is a nomination form for an employee named Shri/Shrimati/Kumari to nominate recipients for payment of gratuity in the event of their death. The form collects information about the employee such as name, department, date of appointment, and nomination of family members to receive gratuity payment. Witnesses are also required to sign the form to validate the nomination.

    Original Title

    Form-F-Nomination-Gratuity Sample (1) (1) (1) (1) (1)

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    The document is a nomination form for an employee named Shri/Shrimati/Kumari to nominate recipients for payment of gratuity in the event of their death. The form collects information about the employee such as name, department, date of appointment, and nomination of family members to receive gratuity payment. Witnesses are also required to sign the form to validate the nomination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    408 views3 pages

    Form-F-Nomination-Gratuity Sample

    Uploaded by

    VENKATESAN B
    The document is a nomination form for an employee named Shri/Shrimati/Kumari to nominate recipients for payment of gratuity in the event of their death. The form collects information about the employee such as name, department, date of appointment, and nomination of family members to receive gratuity payment. Witnesses are also required to sign the form to validate the nomination.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    Payment of Gratuity (Central) Rules

    FORM 'F'
    See sub-rule (1) of Rule 6
    Nomination
    To,
    (Give here name or description of the establishment with full address)

    Great Lakes E-Learning Services Pvt. Ltd.

    EMPLOYEE NAME
    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/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 Write NA or leave it blank (if 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. 100%
    NOMINEE NAME (Should be family members)

    2.
    3.

    Statement
    1. Name of employee in full
    2. Sex
    3. Religion
    4. Whether unmarried/married/widow/widower
    5. Department/Branch/Section where employed DESIGNATION NAME, DEPARTMENT
    6. Post held with Ticket No. or Serial No., if any Write NA or leave it blank (if not applicable)
    7. Date of appointment Date of joining
    8. Permanent address:
    Village – Post District
    State

    Employee’s Signature
    Place:

    Signature/Thumb-impression of the
    Date: Employee

    Declaration by Witnesses

    Nomination signed/thumb-impressed before me


    Name in full and full address of witnesses.

    • Kindly mention 2 witnesses along with their


    actual signatures.
    • Kindly make sure that people mentioned in
    Nomination and Witness columns are
    different

    Signature of Witnesses.
    1. Name and address of 1st Witness

    1. Signature of 1st Witness

    Name and address of 2nd Witness


    2.

    2. Signature of 2nd Witness

    Place:
    Date:
    Certificate by the Employer
    Not to be filled by the employee

    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.

    Employee’s Signature

    Date: Signature of the Employee

    Note.—Strike out the words/paragraphs not applicable.

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