Payment of Gratuity Form H
[See sub-rule (4 ) of rule 6 ]
Modification of nomination
FORM ‘H’
To ………………………………………………………………………………………………….. [Give h ere n a m e or description of the establishment with fulladdress ]
Shri/ Shrimati/ Kumari ……………[Na m e in full h ere] whose particulars a re given in the statement below, hereby give notice that the nomination filled by m eon [date] and recorded under your reference No. ……………… dated …………….. s h a ll s tan d modified in the following manner:
[Hear give details of the modifications in tended]
State m e n t
Place Signature/ Thumb impression
Date of the employee
Declaration by witnesses
Modification of n om in a t ion 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 employ er
Certified that the above modification have been recorded.
Employer,s reference No., if any. Signature of the employer/Officer authorized
Designa t ion
Name and address of the
Acknowledgement by the employee
Received the duplicate copy of the notice for modification in form ‘H’ filed by m eon
……………….. duly certified by the employer.
Date Signature of the employee
Different types of forms of gratuity
Establishment or rubber stamp thereof.