| Re: PF & Gratuity Nomination Forms The payment of Gratuity act has total 21 Forms used for various purposes. The names are :
FORM A-Notice of opening--(Meant for employer)
FORM B--Notice of change of establishment--(Meant for employer)
FORM C--Notice of Closure of establishement-(meant for employer)
FORM D--Notice for excluding husband from family -(Meant for employee)
FORM E--Notice of withdrawal of notice for excluding husband from family
FORM F--Nomination
FORM G--Fresh Nomination--(by means of marriage)
FORM H--Modification of nomination
FORM I--Application of gratuity by an employee
FORM J--Application of gratuity by a nominee
FORM K--Application of gratuity by a legal heir
FORM L--Notice for payment of gratuity
FORM M--Notice rejecting claim for payment of gratuity
FORM N--Application for direction
FORM 0--Notice for appearance before the controlling authority
FORM P--Summons
FORM Q--Particulars of application under section 7
FORM R--Notice for payment of Gratuity
FORM S--Application for recovery of gratuity
FORM T-Application for recovery of gratuity
FORM U--Abstract of the Act and R ules
pl find below the FORM F--meant for employee--for nomination.
FORM 'F'
[See sub-rule (1) of rule 6]
Nomination
To ……………………………………………………………………………………………………………………… …………… ……………
[Give here name or description of the establishment with full address]
I. Shri/Shrimati/Kumari…………………whose particulars are given in the statement below,
[Name in full here]
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 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 a/are 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 dependant on me.
(b) my husband's father/mother/parents is/are not dependant 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 clause (h) of section 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 employee Age of nominee Proportion by which the gratuity will be
shared
1.
2.
3.
so. on.
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 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
Nomination 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 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
Designation
Date Name and address of the
establishment or rubber stamp
thereof.
Acknowledgement by the employee
Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.
Date Signature of the employee
I hope your doubt stands clarified.
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