NomineesRelationship with the employeeAgeAmount or share of gratuity payable to each(*)Contingencies on the happening of which the
nomination shall become invalidName and address and relationship of the person or persons, if any, to whom the right conferred on the
nominee shall pass in the event of the nominee pre-deceasing the employee or the nominee dying after the death of the employee but before
receiving payment of gratuityAmount or share of gratuity payable to each.(**) 1234567This nomination supersedes the nomination made by me
earlier on …………………which stands cancelled. N.B The Officers should draw lines across blank space below the last entry to prevent the insertion
of any name after he has signed. Dated this……………day of …………..200 ………..at…………………………………………...Witness to signature:-
(1)……………………………………………………………….(2 )………………………………………………………………. Signature of employee (*)This column should be filled
in so as to cover the whole amount of gratuity. If only one person is nominated, the words “full” or “hundred percent” shall be indicated in the
column.(**) The amount/share of gratuity shown in this column should cover the whole amount/share payable to the original nominees
