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HGS Form F - Gratuity PDF

1. The document is a nomination form for payment of gratuity after death of the employee. 2. It contains details of the employee such as name, address, family details and nomination of family members to receive gratuity. 3. The employee nominates specific family members, provides their details such as name, address, relationship and proportion of gratuity to be received.

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Kamaraj Sundaram M
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586 views

HGS Form F - Gratuity PDF

1. The document is a nomination form for payment of gratuity after death of the employee. 2. It contains details of the employee such as name, address, family details and nomination of family members to receive gratuity. 3. The employee nominates specific family members, provides their details such as name, address, relationship and proportion of gratuity to be received.

Uploaded by

Kamaraj Sundaram M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM 'F'

[See sub-rule (1) of rule 6]


Nomination
To,
HGS International Services Pvt. Ltd., 4A, 4th Floor, Summerville, Junction of 14th & 33rd Road,
Bandra (W), Mumbai-400050.
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 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
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

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:
Date :

Signature/Thumb impression of the employee


Declaration by witnesses

Nomination signed/thumb impressed before me.


Name in full and full
address of witnesses.
1. Shirish Dhavle

Signature of witnesses.
1.

4A, 4th Floor, Summerville,Junction of 14th & 33rd Road, Bandra (West), Mumbai - 400050.
2. Ketan Shah

2.

4A, 4th Floor, Summerville,Junction of 14th & 33rd Road, Bandra (West), Mumbai - 400050.
Place : Mumbai
Date : 10th September, 2011
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.

Date :

Signature of the employer/Officer authorised


Designation Sr. Associate HR
HGS International Services Pvt. Ltd, 4A, 4th Floor,
Summerville Bldg, Jnct of 14 th & 33rd Road, Bandra (W)
Mumbai-400050
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

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