Payment of Gratuity Form K



FORM 'K'

See sub-rule (3) of Rule 7

 

Application for Gratuity by a Legal Heir

 

To,

(Give here the name or description of the establishment with full address)

Sir/Gentlemen,                                                                                                                                           

                                                                                                                                                                 

 

I beg to apply for payment of gratuity to which I am entitled under sub-section (1) of Section 4 of the Payment of Gratuity Act, 1972, as a legal heir of late                                                                                                                      

                                                                                                            (Name of the Employee)

who was an employee of your                                                                             establishment and  died on

the                                                                       without making any nomination. The gratuity is payable on account of the death of the aforesaid employee while in service/superannuation of the aforesaid employee on

the                                                                                retirement or resignation of the aforesaid employee

on the                                       after completion of                                                       years of service/total

disablement of the aforesaid employee due to accident or disease while in service with effect from
the                                             Necessary particulars relating to my claim are given in the Statement below:

 

 

Statement

 

1.   Name of applicant legal heir                                                                                                                  

2.     Address in full of applicant legal heir                                                                                                      

                                                                                                                                                                 

3.   Marital status of the applicant legal heir (unmarried/married/widow/widower)                                            

4.   Name in full of the employee                                                                                                                 

5.   Relationship of the applicant with the employee                                                                                      

6.   Religion of both the applicant and the employee                                                                                     

7.   Date of appointment and total period of service of the employee                                                             

8.   Department/Branch/Section where the employee worked last                                                                  

9.     Post last held by the employee with Ticket or Sl. No., if any                                                                    

10.  Total wages last drawn by the employee                                                                                                

11.  Date and cause of termination of service of the employee (death or otherwise)                                        

12.  Date of death of the employee and evidence/witness in support thereof                                                   

13.  Total gratuity payable to the employee                                                                                                   

14.  Percentage of the gratuity claimed                                                                                                         

15.  Basis of the claim and evidence/witness in support thereof                                                                     

 

2.   I declare that the particulars mentioned in the above statement are true and correct to the best of my knowledge and belief.

3.   Payment may please be made in cash/open or crossed bank cheque.

4.   As the amount payable is less than Rupees one thousand, I shall request you to arrange for payment of the sum due to me by postal money order at the address mentioned above, after deducting postal money order commission therefrom.

 

Yours faithfully,

Signature/Thumb-impression of applicant

legal heir.

Place:                          

Date:                           

 

Note.—Strike out the words 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 paymen