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    3 - ForM F Gratuity (Sample)

    Uploaded by

    Rajdeep Gaharwar
    The document provides instructions for new employees to fill out only the highlighted sections of a sample gratuity nomination form, and to contact their induction anchor if they have any questions when filling out the actual form separately provided to them. It also includes the sample gratuity nomination form that is to be used only for understanding what information is required, with sections for nominating beneficiaries to receive gratuity payments and providing personal details about the employee.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    3 - ForM F Gratuity (Sample)

    Uploaded by

    Rajdeep Gaharwar
    85 views4 pages
    The document provides instructions for new employees to fill out only the highlighted sections of a sample gratuity nomination form, and to contact their induction anchor if they have any questions when filling out the actual form separately provided to them. It also includes the sample gratuity nomination form that is to be used only for understanding what information is required, with sections for nominating beneficiaries to receive gratuity payments and providing personal details about the employee.

    Original Description:

    Form F

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    The document provides instructions for new employees to fill out only the highlighted sections of a sample gratuity nomination form, and to contact their induction anchor if they have any questions when filling out the actual form separately provided to them. It also includes the sample gratuity nomination form that is to be used only for understanding what information is required, with sections for nominating beneficiaries to receive gratuity payments and providing personal details about the employee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    85 views4 pages

    3 - ForM F Gratuity (Sample)

    Uploaded by

    Rajdeep Gaharwar
    The document provides instructions for new employees to fill out only the highlighted sections of a sample gratuity nomination form, and to contact their induction anchor if they have any questions when filling out the actual form separately provided to them. It also includes the sample gratuity nomination form that is to be used only for understanding what information is required, with sections for nominating beneficiaries to receive gratuity payments and providing personal details about the employee.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    INSTRUCTIONS TO NEW JOINEES:

    • This is only a sample form which has been filled with sample data for your
    understanding.
    • As a new joinee, you only to fill sections highlighted as shown below in the blank sheet
    shared with you separately.
    • In case of any doubts, please contact your induction anchor.

    SAMPLE
    FORM –‘F’
    PAYMENT OF GRATUITY ACT.
    [ SEE SUB-RULE (1) of Rule 6 ]
    NOMINATION
    To,
    …………………………………………………...
    …………………………………………………...

    [ I Give here name or description of the establishment with full address ]


    Ramesh S
    1. Shri/Shrimati……………………………………………………………………………….
    [Name in the here]

    Whose particulars are given in the statement below. I 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 the 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 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 provision 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 the
    address of nominee(s) the employee nominee gratuity will be shared
    (1) (2) (3) (4)
    Siva Father 60 50%

    Shruthi Mother 50 50%


    STATEMENT
    1. Name of the employee in full………Ramesh S…………………………………………
    2. Sex…………………………………Male……………………………………………………
    3. Religion……………………………Hindu……………………………………………………
    4. Whetherunmarried/married/widow/widower……………Married………………………………
    5. Department Branch/Section where employed……BU/Team…………………………….
    6. Post held with Ticket No. Serial No. if any……Designation As per offer letter…….
    7. Date of appointment……………Today’s date………………………………………………..
    8. Permanentaddress………………Address………………………………………………………
    Village………………………………Thana……………………Sub Division……………………
    Post Office………………………….District…………………..State…………………………….
    Place-Chennai/Bangalore/Hyderabad
    Signature/Thumb Impression
    Date……………. of the employee

    Declaration by witnesses
    Nomination signed/Thumb impressed before me
    Name in full and full address of witnesses

    signature of witnesses
    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 authorized


    Designation

    Name address of the establishment


    Date……………….. or rubber stamp there of

    Acknowledgment by the employee


    Received the duplicate of the nomination in Form ‘F’ Filled by me and duly certified by the
    employer.

    Date……………………
    Note: Strike out words/paragraph not applicable Signature of the employee

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