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    FORM F - Gratuity Act

    Uploaded by

    Vikas Sharma
    1. Vikas Sharma submits a nomination form to designate his mother, Savitri Sharma, as the sole beneficiary to receive any gratuity payments due after his death. 2. Vikas provides details about himself such as his name, gender, religion, marital status, department, and date of appointment. 3. The nomination is signed by Vikas and two witnesses and certified by his employer.

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    © All Rights Reserved
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    FORM F - Gratuity Act

    Uploaded by

    Vikas Sharma
    118 views3 pages
    1. Vikas Sharma submits a nomination form to designate his mother, Savitri Sharma, as the sole beneficiary to receive any gratuity payments due after his death. 2. Vikas provides details about himself such as his name, gender, religion, marital status, department, and date of appointment. 3. The nomination is signed by Vikas and two witnesses and certified by his employer.

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    1. Vikas Sharma submits a nomination form to designate his mother, Savitri Sharma, as the sole beneficiary to receive any gratuity payments due after his death. 2. Vikas provides details about himself such as his name, gender, religion, marital status, department, and date of appointment. 3. The nomination is signed by Vikas and two witnesses and certified by his employer.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    118 views3 pages

    FORM F - Gratuity Act

    Uploaded by

    Vikas Sharma
    1. Vikas Sharma submits a nomination form to designate his mother, Savitri Sharma, as the sole beneficiary to receive any gratuity payments due after his death. 2. Vikas provides details about himself such as his name, gender, religion, marital status, department, and date of appointment. 3. The nomination is signed by Vikas and two witnesses and certified by his employer.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    FORM 'F'

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

    Nomination

    To
    Gujarat Pipavav Port Limited

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

    I. Shri/Shrimati/Kumari Vikas Sharma 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 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 Relationship with Age of nominee Proportion by which
    address of nominee(s) the employee the gratuity will be
    shared
    1. Savitri Sharma Mother 49 years 100%

    2.

    3.
    4.

    5.
    Statement

    1. Name of employee in full. : Vikas Sharma


    2. Sex. : Male
    3. Religion. : Hindu
    4. Whether unmarried/married/widow/widower. : Married
    5. Department/Branch/Section where employed.: APM Terminals
    6. Post held with Ticket or Serial No., if any. : Container Commercial Manager R83316
    7. Date of appointment. : 21st January 2024
    8. Permanent address. : A37, Surya Vistar, Dadi ka Fatak, 302012

    Village ……………… Thana ……………… Sub-division ………………. Post Office ………………

    District: Jaipur State: Rajasthan

    Place: Jaipur Signature/Thumb impression


    Date : 18th Deecember 2023 of the employee

    Declaration by witnesses

    Nomination signed/thumb impressed before me.

    Name in full and full Signature of witnesses.


    address of witnesses.

    1.

    2.

    Place: Jaipur

    Date: 18th December 2023


    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 person

    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: 18th December 2023 Signature of the employee

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