FORM 'F' Applicant ID: 2165067

See sub-rule (1) of

Gratuity Nomination Form
To,
TATA Consultancy Services Ltd,
9th Floor, Nirmal Building,
Nariman Point, Mumbai 400021.
1.1, NAMRATA BOSE whose particulars are aiven in the statement below, hereby nominate the person(S) mento
below to receive the gratuity payable after my death 2s also the aratuitystanding to my credit in the event or ny eU
before that amount has become payable. or havina become pavable has not been paid and direct that the sau a
of gratuity shall be paid in proportion indicated against the name(s) of the nominee(s).
2.I hereby certify that the person($) nominated islare a member(s) of my family within the meaning of clause (h) of Secion
2 of the Payment of Gratuity Act, 1972. Yes

3. Ihereby declare that Ihave no family within the meaning of clause (h) of Section 2 of the said Act. NA
4. (a) My father is not dependent on me. No
(b) My mother is not dependent on me. No
(c) My spouse's father is not dependent on my spouse. NA
(d) My spouse's mother is not dependent on my spouse. NA

5. Nomination made herein invalidates my previous nomination.

Nominee(s)
Name in full with full Date of Proportion by Name,relationship and address of
Sr Relationship Guardian if nominee is minor
No. address of nominee(s) with the Birth which gratuity
employee will be shared

Mr. Nirmal Chandra Bose Father 03/07/1958 50

1
Opposite Shanti Apartment,
New Nagra Toli, Circular
Road,Lalpur, Shanti
|Apartment, Ranchi- 834001,
Jharkhand, India 50
Mx. Ita Bose Mother 05/01/1970
2
Opposite Shanti Apartment,
New Nagra Toli, Circular
Road,Lalpur, Shanti
Apartment, Ranchi- 834001,
Jharkhand, India

03-Aug-2024 Page 1 of 2
 Statement
2165067
Full Name: NAMRATA BOSE Applicant ID: 22-Aug-2024
Gender: Date of Joining:
NA
Martial Status:Single Department:
Religion: NA
Permanent Address: Opposite ShantiApartment New
Nagra Toli, Circular Road,Lalpur
Shanti Apartment Ranchi
Jharkhand 834001
Namata lhott .
Date: 04|ot|2024
Place: Ranni SignatureofEmployee:
DECLARATION BY WITNESSES
Nomination signed before me
Signature of Witnesses
SR No. Name in full and full Address of Witnesses
1
[Asim kaNmaRa1 Alean Moníng sleiyphaniay nihamt
Madam Mohen Ghnh3&4 Adashpalli ,Kolkata
Place : Kokata
Date:
CERTIFICATE BY THE EMPLOYER
establishment
have been verified and recorded in this
Certified that the particulars of the above nominations

Signature of the empioyer/trustee

Office Seal

ACKNOWLEDGEMENT BY THE EMPLOYEE

and duly certified by the employer.
Received the duplicate copy of nomination in Form 'F' filed by me
Signature of the employee
Date

03-Aug-2024
Page 2 of 2
 FORM - 2 Applicant ID: 2165067
Pension Number : MH/BAN/48475/
NOMINATION AND DECLARATION FORM EOR UNEXEMPTED/EXEMPTED ESTABLISHMENTS
Declaration and Nomination Form under the Emplovees Provident Eund and Emplovees Pension Scheme (huie zo Or
the Tata Consultancy Services Employees Provident Fund Rules &Paragraph &Paragraph 18 of the Empoye
Pension Scheme, 1995)

1. Name(In Block Letters): NAMRATA BOSE

2. Father's /Husband's Name: Nirmal Chandra Bose
3. Date of Birth:15/07/2001
4. Male/Female : Female

5. Marital Status: Single

6. PF Account Number : MH/BANI48475/
7. Address:
Apartment Ranchi
Permanent : Opposite Shanti Apartment New Nagra Toli, Circular Road,Lalpur Shanti
Jharkhand 834001
Apartment Ranchi
Termporary: Opposite Shanti Apartment New Nagra Toli, Circular Road,Lalpur Shanti
Jharkhand 834001
8. (a)Date of joining EPF Scheme, 1952:22/08/2024
(b)Date of joining E.P.Scheme, 1995 :22/08/2024

PART - A(EPF)
made by me previously and nominate the person(s) mentioned
Ihereby Nominate the person(s) /cancel the nomination Employees Provident Fund, in the event of my Death.
below to receive the amount standing to my credit in the
Total Amount of If the Nominee is minor, name,
Name of the Address of the Nominee's Date of Birth relationship and address of the
share of
Nomineel Nominees Relationship guardian who may receive the
accumulations in
nominees with the
member Provident Fund to be amount during the minority of
paid to each nominee. nominee

05-Jan-1970 50
Ita Bose |Opposite Shanti Mother
Apartment, New
Nagra Toli,
Circular
Road,Lalpur,
Shanti
Apartment,
Ranchi- 834001. 03-Jul-1958 50
Nirmal Opposite Shanti Father
Chandra Bose Apartment, New
Nagra Toli,
Circular
Road,Lalpur,
Shanti
Apartment,
Ranchi- 834001.

M1. Certified that Ihave no family as defined in Para 2(g) of the Employees Provident Fund Scheme, 1952 and
should I
acquire a family hereafter the above nomination should be deemed as cancelled.
2. Certified that my father mother is / are dependent upon me.

03-Aug-2024 Page 1 of 3
 Sigpature uf the subscriberlmember

Page 2 of 3
03-Aug-2024
 PART B (EPS)
(Para 18)
Serial No Name of the Family Address of the Family member Date of Birth Relationship with the
member member

Certified that Ihave no family, as defined in Para 2 (vi) of Emplovees Pension Scheme, 1995 and should I acquire a
family hereafter I shall furnish particulars thereon in the above form.

Thereby nominate the following person for receiving the monthly widow pension (admissible under Para 16 (2)(a)) and
(1) of the Employees Pension Scheme, 1995 in the eventof my death without leaving any eligible farmily member for
receiving pension.
Name of the nominee Address of the nominee Date of Birth Relationship with the
member

Mr. Nirmal Chandra Bose Opposite Shanti Apartment, New 03-Jul-1958 Father
Nagra Toli, Circular Road,Lalpur,
Shanti Apartment, Ranchi- 834001,
Jharkhand, India
Mx. Ita Bose Opposite ShantiApartment, New 05-Jan-1970 Mother
Nagra Toli, Circular Road,Lalpur,
|ShantiApartment, Ranchi- 834001,
Jharkhand, India

Sgndamatu
Date: of the subscriber/member
CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed before me by Shri/ Smt./Kumari NAMRATA BOSE
in my establishment after he/she has read the entries have been read over to him/her by me and got confirmed by
him/her.

Date: Signature of the employer or

Other authorized Officer of the establishment

03-Aug-2024
Page 3 of 3
 Applicant ID: 2165067

Form 9 (Revised)
IHE EMPLOYEES' PROVIDENT FUNDS SCHEME. 1952 (Paragrapn o)
AND

THE EMPLOYEES' PENSION SCHEME, 1995 (Paragraph 24)

which the Employeo
Declaration by a person taking up emplovment in an establishment in
Provident Funds & Employees' Pension Scheme enforce

I, Namrata Bose of Sh. Nirmal Chandra Bose do hereby solemnly declare that:
NA W
left service on NA prior to that, Iwas employed in NA,
(a)was employed with NA, NA with PF A/c Number NA and
PFA/c Number NA from NA to NA.

(b) lam a member of the Pension Fund from NA to NA

(c) Ihave withdrawn the amount of my Provident Fund. - NA

(d) Ihave withdrawn the amount of my Pension Fund. - NA

Scheme, 1995 in respect of my past service in any

(e) Thave drawn any benefits under the Employees Pension
establishment. - NA
Social
programme in NA from NAto NA, which has not entered into a
)Thave not contributed to the social security
Security Agreement with India.

No
(g) Do you have a Universal Account Number (UAN):
Aadhar NPR PAN
Universal Account Number
NA FWEPB7175N
NA 4515-0949-2478

(h) Bank Account Number Linked with UAN:NA

Bank Account Number IFSC Code

NA NA

Date :ou|oa|2029 Signature of employee

(To be filled by the employer)

1) Shri/Smt/Kumari Namrata Bose is appointed as Systems Engineer in Tata Consultancy Services Limited, with effect from
22-AUG-2024 bearing Provident Fund Account Number: MH/BANI48475/000/

03-Aug-2024 Page 1 of 2
 Tata Consultancy Services Limited
10th Floor, Air India Building, Nariman Point
Mumbai 400 021.

AamvatgBote,.