[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 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
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
Date of the employee
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
- A P SHOP & ESTB. ACT
- ACT - CHAPTERS WISE ::
- Ch-IV: SHORT TITLE AND APPLICATION
- REGISTRATION OF ESTABLISHMENTS
- CHAPTER III : SHOPS
- Ch-IV: EST. OTHER THAN SHOPS
- Ch-V: EMPLOYMENT OF WOMEN, CHILDREN
- Ch-VI: HEALTH AND SAFETY
- Ch-IV: ESTAB. OTHER THAN SHOPS
- Ch-VII: LEAVE, HOLIDAYS AND INSURANCE
- Ch-VIII: WAGES, CONDITIONS FOR TERMINATION
- Ch-IX: APPOINTMENT POWERS AND DUTIES ETC.,
- Ch X: DUTIES OF THE CHIEF INSPECTOR
- Ch XI : PENALTIES FOR OFFENCES
- CHAPTER XII : MISCELLANEOUS
- THE AP SHOPS and ESTABLISHMENTS RULES - 1990
- AP REGISTRATION AND LICENSING
- FREQUENTLY ASKED QUESTIONS
- 365 DAYS EXTENSIONS
- COST OF LIVING ALLOWANCES - CPI Points
- ACT - CHAPTERS WISE ::
- CONTRACT LABOUR
- EPF ACT
- E S I ACT
- INFORMATION ON ESIC
- GENERAL REGULATIONS ::
- CENTRAL RULES ::
- CHAPTER I - SHORT TITLE AND EXTENT and; DEFINITIONS
- CHAPTER II CORPORATION, STANDING COMMITTEE AND MEDICAL BENEFIT COUNCIL
- CHAPTER III - FINANCE AND AUDIT
- CHAPTER IV - CONTRIBUTIONS
- CHAPTER V - BENEFITS
- CHAPTER V-A : TRANSITORY PROVISIONS
- CHAPTER VI- ADJUDICATION OF DISPUTES AND CLAIMS
- CHAPTER VII- PENALTIES
- CHAPTER VIII- MISCELLANEOUS
- SCHEDULE II
- SCHEDULE III
- BENEFITS ::
- Information for employers ::
- EXPERTS VIEWS ::
- Recent Case Laws ::
- APPLICABILITY OF THE ACT
- COVERAGE OF EMPLOYEES ENGAGED THROUGH A CONTRACTOR
- COVERAGE OF ESTABLISHMENTS UNDER THE ACT
- COVERAGE OF SHOPS UNDER THE ACT
- DAMAGES INTEREST FOR LATE OR NON-DEPOSIT OF CONTRIBUTIONS
- 'EMPLOYEE' UNDER THE ACT
- EMPLOYEES’ INSURANCE COURT
- APPEAL-EMPLOYEES' INSURANCE COURT
- PROSECUTION UNDER THE ACT
- RECOVERY OF CONTRIBUTIONS
- WAGES' FOR ESI'S CONTRIBUTION
- MISCELLANEOUS
- FREQUENTLY ASKED QUESTION ::
- OTHER ACTS::
- THE PAYMENT OF GRATUITY ACT, 1972
- THE WORKMEN’S COMPENSATION ACT, 1923
- THE PAYMENT OF BONUS ACT, 1965
- THE MINIMUM WAGES ACT, 1948
- THE PAYMENT OF WAGES ACT, 1936
- INDUSTRIAL EMPLOYMENT (S O) ACT, 1946
- THE INDUSTRIAL DISPUTES ACT, 1947
- THE TRADE UNIONS ACT, 1926
- THE MATERNITY BENEFIT ACT, 1961
- THE CHILD LABOUR (P AND R) ACT, 1986
- THE MOTOR TRANSPORT WORKERS ACT, 1961
- THE WEEKLY HOLIDAYS ACT, 1942
- THE A P Holidays Act, 1974
- JUDGMENTS’10
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