REQUEST FOR WITHDRAWAL / TRANSFER OF GRATUITY FUND

The Trustees Date: JANUARY 19, 2022

The Indian Hotels Employees Gratuity Trust

Dear Sir,
I hereby request you to pay me the full amount standing to my credit in the Fund after making such
deductions as may be authorized under rules. I am giving below my particulars:-

1. Name (In block letters) OMPRAKASH MAMGAI

2. Date of joining the Company 19-December-2002

3. Date of leaving the service 20-December-2016

4. Period of Service 14 YEARS

5. Reason for leaving the service RESIGNATION

6. Date of Birth 15-January -1977

7. PAN No. (Please attach Pan Card copy) ARSPM3364Q

8. Amount to be credited to : (Please attach cancelled blank cheque)

Bank Name & Bank Account No: STATE BANK OF INDIA & 32803845097
Branch name & address NALLASOPARA & SHOP NO. 5,6,7,8,9,10,A WING
SARASWATI
IFSC Code: SBIN0012940

9. E mail & Mobile no. mamgaiomprakash1977@gmail.com & +1(869) 661-9824

OMPRAKASH MAMGAI 000379

FULL NAME SIGNATURE TICKET NO.

FOR THE USE OF PERSONNEL DEPARTMENT / HR DEPARTMENT

Certified that the particulars given above are correct as per the records.
Salary on the date of Resignation / Retirement:

Date of Service served in Indian From To

Date of Service served in Abroad From To

BASIC:

FDA:

VDA:

TOTAL:

Signature & Designation of the Authorized Executives

__________________________ __________________________ ___________________

Manager - Human Resource Human Resource Corporate Payroll
Corporate/ Brand

Date _________________ Date ___________________ Date ____________