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Gratuity Form

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Submitted By farokhs
Words 444
Pages 2
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FORM 'F'

GRATUITY NOMINATION

To

I. …..…………………………………… whose particulars are given in the statement below, [Name in full here] 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 dependent on me.

b) My spouse’s father/mother/parents is/are not dependent on my spouse.

5. I have excluded my husband from my family by a notice dated ………………..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 address |Relationship with the employee |Age of nominee |Proportion by which the gratuity|
|of nominee(s) | | |will be |
| | | |Shared |
|1. | | | |
|2. | | | |
|3. | | | |
|so on. | | | |
| | | | |

I GIVE BELOW THE PARTICULARS ABOUT MYSELF

1. Full name. 2. Employee No.

3. Sex. 4. Religion 5. Date of Birth

6. Date of appointment 7. Marital Status: .

8. Father/ Husband’s name.

9. Permanent address
Village ……………… Thana ……………… Sub-division ………………. Post Office ………………

District ………………. State…………………

In the event of my death during the minority of above named nominee, I hereby direct that the person (s) whose particulars are given below shall be deemed to be the guardian of the minor nominee for the purpose of the IBM INDIA PVT LTD EMPLOYEES GRATUITY FUND TRUST.

|SL No |Name of the |Age of the |Name & Address of the |Relationship |
| |Nominee |Minor |Guardian | |

Place Signature/Thumb impression
Date of the employee

Declaration by witnesses

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.

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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