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)
Us Tech Solutions Pvt Ltd , AWFIS, N Heights , Plot No 38, Phase 2, Siddiq Nagar,
Hi Tech City, Hyderabad, Telangana-500081
I, Shri/Shrimati/Kumari Bharadhwaj Uppala
(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 Relationship with Age of Proportion by which
address of nominee(s) the employee nominee the gratuity will be
shared
(1) (2) (3) (4)
1. sridhar uppala father 59 100%
2.
3.
So
on.
Statement
1. Name of employee in full bharadhwaj uppala
2. Sex male
3. Religion Hindu
4. Whether unmarried/married/widow/widower Unmarried
5. Department/Branch/Section where employed IT Dept
6. Post held with Ticket No. or Serial No., if any Employee ID : 135660
7. Date of appointment 18th August 2025
8. Permanent address: 11-14-262/1,2,3 D202 Manjeera heights 2, chitra layout, lb nagar
Village Thana Sub-division
Post Office District Ranga reddy State Telangana
Place: Hyderabad, TG
Signature/Thumb-impression
of the Employee
Date:
29th August 2025
Declaration by Witnesses
Nomination signed/thumb-impressed before me
Name in full and full address of witnesses. Signature of W itnesses.
1. bhagya lakshmi uppala 1.
11-14-262/1,2,3 D202 manjeera heights 2, chitra layout, lb nagar, Hyderabad, TG,
500074
2. Sneha lekha uppala 2.
11-14-262/1,2,3 D202 manjeera heights 2, chitra layout, lb nagar, Hyderabad, TG,
500074
Place: Hyderabad, TG
Date: 29th August 2025
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 Employee Id : 135660 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: 29th August 2025 Signature of the Employee
Note.—Strike out the words/paragraphs not applicable.
