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FORM F Nomination

1. The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. It requests information about the employee such as name, sex, religion, marital status, department, and address. 3. The employee provides details of the nominated beneficiaries including their name, address, relationship to the employee, age, and the proportion of gratuity they are to receive.

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171 views2 pages

FORM F Nomination

1. The document is a nomination form for an employee to nominate beneficiaries to receive gratuity payments in the event of the employee's death. 2. It requests information about the employee such as name, sex, religion, marital status, department, and address. 3. The employee provides details of the nominated beneficiaries including their name, address, relationship to the employee, age, and the proportion of gratuity they are to receive.

Uploaded by

S S ENTERPRISES
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM F

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


NOMINATION

To,
CORONA Remedies Private Limited
Corona House, "C" Mondeal Business Park,
Near Gurudwara, S. G. Highway,
Thaltej, Ahmedabad – 380059

1. Shri/Shirman/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 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 of Relationship Age of Proportion by
nominee(s) with the nominee which the
employee gratuity will
be shared
(1) (2) (3) (4)
1.
2.
3.
4.
So on
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 No. or Serial No., if any : __________________________________
7. Date of appointment : __________________________________
8. Permanent address : __________________________________

Village Thana Sub-division


Post Office District State
Place:
Date: Signature/Thumb-impression of the Employee
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

Note—Strike out the words/paragraphs not applicable.

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