FORM ‘F’
[See sub-rule (1) of rule 6]
Nomination
To,
Vedantu Innovations Private Limited,
# 1081,18th Cross, 14th main Sector -3, HSR Layout, Bangalore-560102.
I, Shri/ Shrimati/ Kumari … [mention your full name 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 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 date the …Not Required… to the
controlling authority in terms of the proviso to clause (h) of section 2 of the said Act.
6. Nomination made herein in validates my previous nomination.
Nominee(s)
Name in full Relationship
Age of
S. No. with address of with the Proportion by which the gratuity
nominee
nominee(s) employee will be shared
so on.
Statement
Name of the employee in full
Sex
Religion
Whether unmarried / married / widow / widower
Department / Branch / Section where employed
Post held with Ticket or Serial No., if any
Date of appointment
Permanent address
Village………………. Thana …………………. Sub-division ……………… Post Office…
Place:
Date: Signature / Thumb impression of the employee
______________________________________________________________________________
Declaration by witnesses
Nomination signed / thumb impressed before me.
Name in full and full 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 …Emp. ID…
Date:
Signature of the employer / Officer authorized Designation
Nam e 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
13-11-24
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