FORM F
[See sub-rule
(1) of rule 6]
NOMINATION
To.
………………….
(Give here name or description of the establishment with full address)
1. 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 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 member(s) of my family within the meaning of Cl. (h) of Sec. 2 of the Payment of Gratuity Act, 1972.
3. I hereby declare that I have no family within the meaning of Cl. (h) of Sec.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 Cl. (h) of Sec.2 of the said Act.
6. Nomination made herein invalidates my previous nomination.
NOMINEE(S)
|
Name in full with full address of nominee(s) |
Relationship with the employer |
Age of nominee |
Proportion by which the gratuity will be shared |
|
1 |
2 |
3 |
4 |
|
1. 2. 3. 4 and so on. |
|
|
|
1. Name of employee in full.
2. Sex.
3. Religion.
STATEMENT
4. Whether unmarried/married/widow/widower.
5. Department/Branch/Section where employed.
6. Post held with Ticket 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.
Fresh nomination signed/thumb-impressed before me.
Name in full and full address of: Signature of witnesses:
1……………….. 1…………………….
2……………….. 2……………………..
Place……………….. Date………………..
CERTIFICATE BY THE EMPLOYER
Certificate that the particulars of the above nomination have been verified and recorded in this establishment.
Employer’s Reference No., if any.
Date……………..
Signature of the employer/
officer authorised.
Designation. Name and address of the establishment
Or rubber stamp thereof
Received the duplicate copy of nomination in Form f filed by me and duly certified by the employer.
Date………………. Signature of the employer.
Note,- strike out the words and paragraphs not applicable.
Different types of forms of gratuity
| Form Name | Use of Form |
| Gratuity Form I |
Application for the payment of gratuity |
| Gratuity Form J | Used by the nominee to make application for payment of gratuity |
| Gratuity Form K | Used by legal heir to make application for the payment of gratuity |
| Gratuity Form F | To make nomination |
| Gratuity Form G | To make fresh nomination |
| Gratuity Form H | Modification of nomination |
| Gratuity Form L | Issued by the employer to employee stating amount and date of payment |
| Gratuity Form M | Issued by the employer stating the reason for the rejection of gratuity |
| Gratuity Form N | Application
made to the labour commissioner by an employee |
| Gratuity Form 0 | Issued by the authority to appear for case hearing |
| Gratuity Form P | Summons issued by the authority to be present for hearing |
| Gratuity Form R | Issued by the authority directing to make gratuity payment |