Payment of Gratuity (Central) Rules

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

To
Incture Technologies Pvt Ltd
No 27/ B, Konappana Agrahara,
Begur Hobli, Electronic City, Bangalore KA 560100.
whose
1, Shri/ Shrimati /Kumari LoKANAIH.MoHANTY..
nominate the per[on(s) mentioned below to
Peluedlars are given in the statement below. hereby credit in the event or
as also the gratuity standing to my has
Tecelve the gratuity payable after my deathpavable not been paid
or having become payable
Ty death before that amount has become proportion indicated against the name(s)
and direct that the said amount of aratuity shall be paid in
of the nominee(s).
2. Ihereby 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. said
the meaning of clause (h) of Section 2 of the
3. Thereby declare that I have no family within
Act.
4 (a) My father/mother/parents islare not dependent on me.
husband.
(b) My husband's father/mother/parents islare not dependent on my to the controlling
5. Ihave excluded my husband from my family by a notice dated the
Act.
authority in terms of the proviso to clause (h) of Section 2 of the said
6. Nomination made herein invalidates my previous nomination.

Nominee(s)

Relationship with Age of Proportion by which

Name in full with full
the employee nominee the gratuity willbe
address of nominee(s)
shared

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

1. AT/POTAGANNATH PRASAD Father 60

2. GANIAM EllaLoDISAt
3
4

Statement
1. Name of employee in full ANSHDMAN OHAN/
2. Sex MALA
Religion
3. Whether unmarried/married/widow/widower
4.
employed
5. Department/Branch/Section where
No., if any
6. Post held with Ticket No. or Serial
7. Date of appointrment_ o2/D42024
8. Permanent address:

Post Office District State DDISHA

Place:
Date: Da.04d0y
Signature/Thurnb-irmpression of
the Employee

Declaration by Witnesses

Nomination signed/thumb-impressed before me

Name in full and full address of witnesses. Signature of Witnesses.

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

authorized Designation

Date: Name andaddress of the establishment

or rubber stamp thereof.

Acknowledgement by the Employee

Docived the duplicate copy of nomination in Form "F filed by me and duly certified bythe
employer.

Date: 02.04 2024 Signature of the Employee