FORM 'F'

Nomination

To,
(Give here name or description of the establish1nent with fuli
address)
-AR_NDIA LMITED, AIRLINES, HOLSE3
GURUDw.ARA RAKABaANTROADNS DELt-uQoO
1,Shrn/Shrimati ANUK6T
(Name tth ful! here)
whosepartitularsaregiveninthestatenmentbeow I nereoyrominateheoerson(sjmentionedbelow to receve
the galui!y pay Ttle after y deotf as alsu the gratuity standig to rny crcdit in the event of
mydeathbeforethatamounthasbecomepayabBe, orhavingbecornepayablehasnotbeenpaidand direct that the
saidamQunt oi 2 310tv shaii be paid in proporton iioicateáarainsube naine(s)of the noiee(s).

2. Ihereby cerify that the person(s) namIínated is l äre a member(s) of my family wit hin the meaning of
clause (h) o Section 2 of the Payment of Graruity'ACt,1972

3
iherebydeclarethatihavenofamitywithinthemeaningotrtausethloiSection2ofthesaidAct.

(a) My father/mother/parents isfare not dependent onme.

(b) MMy hushand's father/mother/parents is/are not dependent on my husbard.

5. ihaveexcludedmyhusband fremmyfamilybyanoticedatedthe. to

thecontroilingauthorityintermsoftheproviso toriatuse{t:jofSection2oftiesaidAct.

6 Nominaton nade herein invalidates my previousnominations.

Nominee(s)

Name in hul Kelationship with Age ot Proportionbywhich

with fut
the employec nominec the gratuity willbe
address of
shared
nominee(s)
(3)

1 ANITYA KUNARkuNDU EATHER o56

(2/1 SRESNATH MUkHERTLE
2
tAEKOtKATA=ÕO3O
3

4,

5.
 Statcment

Nameoternployccntul. ANKET
MALE
Reigio,
UNMA RRGD
Whotherunmaried/married/widow/wiGowe oPERATLONs
Department/8ranch/Scctionwhereemployed. FLLGHI
eLOT.
itaryTRANEE
POst held witn Ticket No. or Seral No,
Oateifappontnent 24 lo/2023
Suo division,
PemaentaddC5
ViBage koLKATA Thana
State
wEST eENGAL
Distct OLKATA
Post Offi GHUGHUD ANGA

Place: HYDERAYBAD siGnaturc/Thubimpressionofthctmployec

Date 23/04|23.
Declaration by Witnesses

thumb-irnoressed before ie N e Signature of Wiesses

Norninaton siened/
vitnesses
fuli anc fuil aodress of Vineyalk
lRTHAMESM SHANkAR LAp. Sos,-MuM6AI -)2
i. lanel Village
ART. B-Pawadkow Mag.,. KRUNAMOYEE HOUS)NG 2.

2.A4USH SAHA, f3214,

8gLR-D, SALAcE, KsLRATA7D04|
EsTAHE,YDERA64)
PiJre Dat

e:
28042023
Employer
Certificate by the
recorded in this
verileu and
abOve nonnatia have een
artcuars af he
(ertirg that !hep
Cstabishmert
employer/Officer authorized
Sgnature of the
fmployer'sReferenceNo ,ifarny Designalion
the
cstablishment or
Name and address of
02tc. rubber stamp thercof

Employee
Acknowledgement by the

13
Recevedtheduptratecopyotnomnation1nt ormtucdtyImeanddutycerttfiedbythecmpiOye 287/23
Signature of thetmployec

Note. Strike out the words/paragraphs not applicable.