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Gratuity Form - F_Preeti

Preeti Mareguddi has submitted a nomination form to Infosys BPM Limited, designating her mother, Pushpa Mareguddi, as the sole recipient of her gratuity upon her death. She certifies that her mother is a dependent family member and that this nomination invalidates any previous nominations. The form includes personal details about Preeti, her employment, and witness declarations.

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13 views

Gratuity Form - F_Preeti

Preeti Mareguddi has submitted a nomination form to Infosys BPM Limited, designating her mother, Pushpa Mareguddi, as the sole recipient of her gratuity upon her death. She certifies that her mother is a dependent family member and that this nomination invalidates any previous nominations. The form includes personal details about Preeti, her employment, and witness declarations.

Uploaded by

mailme2vinod88
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Employee No.

9108411

FORM 'F'
See sub-rule (1) of Rule 6

Nomination

To,

Infosys BPM Limited


Plot No.26/3,26/4, & 26/6,
Electronics City, Hosur Road,
Bangalore- 560 100

I, PREETI MAREGUDDI
whose particulars are given in the statement below, 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/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 NA 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 Relationship with the Age of nominee Proportion by which
address of nominee(s) employee the gratuity will be
shared

(1) (2) (3) (4)

1. PUSHPA MAREGUDDI MOTHER 57 100%

2.
3.
4
5
6
7
< Total % of share should be 100% >
Statement
1. Name of employee in full PREETI MAREGUDDI
2. Sex FEMALE
3. Religion HINDU
4. Whether unmarried/married/widow/widower UMARRIED
5. Department/Branch/Section where employed < Leave this Blank >
6. Post held with Ticket No. or Serial No., if any PROCESS TRAINEE
7. Date of appointment 16-DEC-2024
8. Permanent address: D/O JAGADEESH PANCHAVATI BUILDING NEAR RAYARAMATH MALAMADDI
DHARWAD 580007
Village Thana Sub-division
Post Office District State

Place: BANGALORE

Signature/Thumb-impression of the
Employee
Date: 16-12-2024

Declaration by Witnesses
Nomination signed/thumb-impressed before me
Name in full and full address of witnesses. Signature of Witnesses.
1. Poornima Mareguddi 1. Poornima

2. S C Mariguddi 2. Sangappa

Place:Mysore
Date: 16-Dec-2024

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: Infosys BPM Limited,


Plot No.26/3,26/4, & 26/6,
Electronics City, Hosur Road,
Bangalore- 560 100
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


Note.—Strike out the words/paragraphs not applicable.

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