FORM 'G'

See sub-rule (3) of Rule 6

 

Fresh Nomination

 

To,

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

                                                                                                                                                                 

                                                                                                                                                                 

 

I, Shri/Shrimati/Kumari                                                                                                                                

                                                                                    (Name in full here)

whose particulars are given in the statement below, have acquired a family within the meaning of clause (h) of Section 2 of the Payment of Gratuity Act, 1972 with effect from the                                                               (date here)

                                                in the manner indicated below and therefore nominate afresh 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 said Act.

3.   (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.

4.   I have excluded may husband from may 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.

 

 

 

Nominee(s)

 

Name in full with full
address of nominee(s)

Relationship with the employee

Age of nominee

Proportion by which
the gratuity will be
shared

(1)

(2)

(3)

(4)

1.

 

 

 

 

2.

 

 

 

 

3.

 

 

 

 

So on.

 

 

 

 

 

 


 

Manner of acquiring a “Family”

 

(Here give details as to how a family was acquired, i.e., whether by marriage or parents being rendered dependent or through other process like adoption)

 

 

 

Statement

 

1.   Name of employee in full                                                                                                                      

2.   Sex                                                                                                                                                     

3.   Religion                                                                                                                                               

4.   Whether unmarried/married/widow/widower                                                                                           

5.   Department/Branch/Section where employed                                                                                         

6.   Post held with Ticket No. or Serial No., if any                                                                                         

7.   Date of appointment                                                                                                                             

8.     Permanent address:

      Village                                            Thana                                          Sub-division                                

      Post Office                                     District                                         State                                          

 

 

Place:                                      

Signature/Thumb-impression of the

Employee

Date:                                       

 

 

Declaration by witnesses

 

Fresh nomination signed/thumb-impressed before me.

Name in full and full address of witnesses.                                              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.                                   

Signature of the Employer/Officer authorised.

Date:                                                                                     Designation                                                   

                                                                                                                            Name and address of the establishment or                                                        

                                                                                             rubber stamp  thereof.                                   

                                                                                                                                                                 

                                                                                                                                                                 

 

 

Acknowledgement by the Employee

 

Received the duplicate copy of the nomination in Form                                     filed by me on                       

duly certified by the employer.

Date:                                                                                                                Signature of the Employee.

 

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