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The Gazette of India

EXTRAORDINARY

PART II—Section 3—Sub-section (i)

PUBLISHED BY AUTHORITY

No. 240 NEW DELHI, SATURDAY,SEPTEMBER 16, 1972/BHADRA 25, 1894

Separate paging is given to this Part in order that it may be filed

as a separate compilation.

MINISTRY OF LABOUR AND REHABILITATION

(Department of Labour and Employment)

NOTIFICATION

New Delhi, the 16th September 1972

G.S.R. 412(E).—In exercise of the powers conferred by sub-section (1) of section 15 of the Payment of Gratuity Act, 1972 (39 of 1972), the Central Government hereby makes the following rules, namely:—

1. Short title and commencement.— (1) These rules may be called the Payment of gratuity (Central) Rules. 1972.

(2) These rules shall come into force on the 16th September, 1972.

2. Definitions—In these rules, unless there is anything repugnant in the subject of context.—

(a) "Act" means the Payment of Gratuity Act, 1972; (b) "appellate authority" means the Central Government or the authority specified by the Central Government under sub-section (7) of section 7;

(c) "Form" means a form appended to these rules; (d) "nomination" means nomination made under section 6; (e) "section" means a section of the Act.

(1115)

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3. Notice of opening, change or closure of the establishment.—(1) Within thirty days of the rales becoming applicable to an establishment, a notice in Form 'A shall be submitted by the employer to the controlling authority of the area.

(2) A notice In Form 'B' shull be submitted by the employer to the controlling authority of the area within thirty days of any change In the name, addrets, employer or nature of business.

(3) Where an employer intends to close down the business, he shall submit a notice in Form 'C to the controlling authority of the area at least sixty days before the intended closure.

4. Display of Notice.—(1) The employer shall display conspicuously a notice at or near the main entrance of the establishment in bold letters in English and in a language understood by the majority of the employees specifying the name of the oiticer with designation authorised by the employer to receive on his behalf notices under the Act or the rules.

(2) A fresh notice shall be displayed immediately after the notice referred to in sub-rule (1) becomes illegible or requires a change.

5. Forjn of notice under proviso to section K(h)(ii).—(1) A notice under the proviso to sub-clause (ii) of clause (h) of section 2 shall be in Form D and sent in triplicate by the employee to the employer, who shall, after recording its receipt on one copy thereof, return the copy to the employee and send the second copy to the controlling authority of the area.

(2; An employee may withdraw the notice referred to in sub-rule (1) by giving another notice in triplicate in Form 'E' to the employer, who shall follow the same procedure as in sub-rule (1).

G, Nominations.—(1) A nomination shall be in Form 'F' and submitted in duplicate by personal service by the employee, after taking proper receipt or by .sending through registered post acknowledgement due to the employer,—

(i) in the case of an employee who is already hi employment for a year o; more on the date of commencement of thetie rules, ordinarily, within ninety days from such date, and

(ii) in the case of an employee who completes one year of service after the date of commencement of these rules, ordinarily, within thirty days of the completion of one year of service:

Provided that nomination in Form 'F' shall be accepted by the employer after the specified period, if filed with reasonable grounds for delay, and no nomination so accepted shall be invalid merely because it was filed after the specified period.

(2) Within thirty days of the receipt of a nomination In Form 'F' under sub- rule (1), the employer shall get the service particulars of the employee, as mentioned in the form of nomination, verified with reference to the records of the establish- ment and return to the employee, after obtaining a receipt thereof, the duplicate copy of the nomination in Form 'F' duly attested either by the employer or an officer authorised in this behalf by him. as a token of recording of the nominal ion by the employer and the other copy of the nomination shall be recorded.

(U) An employee who has no family at the time of making a nomination shall, within ninety days of acquiring a family submit in the manner specified in sutnrule (1), a fresh nomination, as required under sub-section (4) of section 6, in duplicate in Form 'G' to the employer, and thereafter the provisions of sub-rule (2) shall apply mutatis mutandi as if it was made under sub-rule (1).

(4) A notice of modification of a nomination, including cases where a nominee predeceases an employee, shall be submitted in duplicate in Form 'H' to the employer in the manner speclfie.d in sub-rule (1), and thereafter" the provisions of sub-rule (2) shall apply mutatis mutandis as if it was made under sub-rule (1).

(5) A nomination or a fresh nomination or a notice of modification of nomination shall be signed by the employee or, If illiterate, shall bear his thumb impression, in the presence of two witnesses, who shall also sipn a declaration to that effect in the nomination, fresh nomination of notice of modification of nomination, as the case may be.

(il) A nomination, fresh nomination ur notice of modiilcatiorj oi! nomination shall take effect from the date of receipt thereof by the employer.

7. Application for gratuity.—(1J An employee who is eligible for payment of gratuity under the Act, or any person authorised in writing, to act on his behalf, shall apply, ordinarily within thirty days from the date the gratuity became pay- able, in Form T to the employer;

Provided that where the date of superannuation or retirement of an employe; is known, the employee may apply to the employer before thirty days of the dati of superannuation or retirement.

(2) A nominee of an employee who IK eligible for payment of gratuity under the second proviso to sub-section (1) of Section 4 shall apply, ordinarily within thirty days from the date the gratuity became payable to him, in Form 'J' to the employer:

Provided that an application in plain paper with relevant particulars shall also be accepted. The employer may obtain such other particulars as may be deemed necessary by him.

(3) A legal heir of an employee who is eligible for payment of gratuity under the 3-eciiod proviso to sub-section (.1) of Section 4 shall apply, ordinarily within one year from the date the gratuity became payable to him, in Form 'K' to the pmplover.

(4) Where gratuity becomes payable under the Act before the commencement of these rules^ tEe periods of limitation specified in sub-rules (10. (2) and (3) shall be deemed to be operative from the date of such commencement.

(0) An application for payment of gratuity filed after the expiry of the periods specified in this rule shall also be entertained by the employer, if the applIcanT adduces sufficient cause for the delay in preferring his claim, and" no claim for gratuity under the Act shall he invalid merely because the claimant failed to present his application within the specified period. Any dispute in this regard shall t>f referred to the controlling authority for his decision.

(G) An application under this rule shall be presented to the employer either by personal service or by registered post acknowledgement due.

8. Notice for payment of ffratuity.- (1) Within fifteen days of the receipt of an application under rule 7 for payment of gratuity, the employer shall—

(i) if the claim is found admissible on verification, issue a notice in Form 'L' to the applicant employee, nominee or legal heir, as the case mav be, specifying the amount of gratuity payable and fixing a date, not being later than the thirtieth day after the date of receipt of the application, for payment thereof, or

(ii) if the claim for gratuity is not found admissible, issue a notice in Form 'M' to the applicant employee, nominee or legal heir, as the case may ibe, specifying the reasons why the claim for gratuity is not considered admissible.

In either case a copy of the notice shall be endorsed to the controlling authority.

(2) In case payment of gratuity is due to be made in the employer's office, the date fixed for the purpose in the notice in Form 'L' under clause (1) of sub-rule (1) shall be re-fixed by the employer, if a written application in this behalf is made by the payee explaining why it is not possible for him to be present in person on the date specified.

(3) If the claimant for gratuity is a nominee or a legal heir, the employer may ask for such witness or evidence as may be deemed relevant for establish- ing his identity or maintainability of his claim as the case may be. In that case the time limit specified for issuance of notices under sub-rule (1) shall be opera- tive with effect from the date such witness or evidence as the case may be called for by the employer is furnished to the employer.

(4) A notice in Form 'L' or Form 'M' shall be served on the applicant either by personal service after taking receipt or by registered post with acknowledge- ment due.

(5) A notice under sub-section (2) of section 7 shall be in Form 1A

9. Mode frf payment of gratuity.—The gratuity payable under the Act shall be paid in cash or, if so desired by the payee, in Demand Draft or bank cheque to the eligible employee, nominee or legal heir, as the case may be.

Provided that in case the eligible employee, nominee or legal heir, as the (.•ase may be, so desires and the amount of gratuity payable is Jess than onf thousand rupees, payment may be made by postal money order after deducting the postal money order commission therefor from the amount payable:

Provided further that intimation about the details of payment shall also be given by the employer to the controlling authority of the area.

10. Application to controlling authority for direction.— (1) If an employer

(i) refuses to accept a nomination or to entertain an application sought to be filed under rule 7, or

(ii) issues a notice under sub-rule (1) of rule 8 either specifying an amount of gratuity which is considered by the applicant leas than what is payable or rejecting eligibility to payment of gratuity, or

(iii) having received an application under rule 7 falls to issue any notice as required under rule 8 within the time specified therein,

the claimant employee, nominee or legal heir, as the case may be, may, within ninety days of the occurrence of the cause for the application, apply in Form 'N' to the controlling authority for issuing a direction under sub-section (4) of section 7 with as many extra copies as are the opposite party:

Provided that the controlling authority may accent any application under this sub-rule, on sufficient cause being shown by the applicant, after the expiry of the specified period.

(2) Application under sub-rule (1) and other documents relevant to such an application shall be presented in person to the controlling authority or shall be sent by registered post acknowledgement due.

11. Procedure for dealing with application for direction.—(1) On receipt ol an application under rule 10 the controlling authority shall, by issuing a notice in Form 'O', call upon the applicant as well as the employer to appear before him on a specified date, time and place, either by himself or through his autho- rised representative together with all relevant documents and witnesses, if any.

(2) Any person desiring to act on behalf of an employer or employee, nominee or legal heir, as the case may be. shall present to the controlling authority a letter of authority from the employer or the person concerned, as the case may be. on whose behalf he seeks to act together with a written statement explaining his interest in the matter and praying for permission so to act. The controlling authority shall record thereon an order either according his approval or specify- ing, in the case of refusal to grant the permission prayed for, the reasons for the refusal.

(*3) A party appearing by an authorised representative shall be. bound iby the acts of the representative.

(4) After completion of hearing on the date fixed under sub-rule (1), or after such further evidence, examination of documents, witnesses, hearing and enquiry, as may be deemed necessary, the controlling authority shall record his finding as to whether any amount is payable to the applicant under the Act. A copy of the finding shall be given to each of the parties.

(5) If the employer concerned fails to appear on the specified date of hearing after due service of notice without sufficient cause, the controlling authority may proceed to hear and determine the application ex-parte. If the applicant fails to appear on the specified date of hearing without sufficient cause, the controlling authority may dismiss the application:

' Provided that an order under this sub-rule may, on good cause being show within thirty days of the .aid order, be reviewed and the: application re-heaid after giving not less than fourteen days' notice to the opposite party of the dale fixed for re-hearing of the application.

12. Place and time of hearing.—The sittings of the controlling authority shall be held at such times and at such places as he may fix end he shall inform the parties of the same in such manner as he thinks fit.

13. Administration of oath.—The controlling authority may authorise a clerk of his office to administer oaths for the purpose of making affidavits.

M. Summoning and attendance of witnesses.—The controlling authority may, a I any stage of the proceedings before him, either upon or without an application by any of the parties involved in the proceedings before him, and on such terms as may appear to the controlling authority just, issue summons to any person in Form 'P* either to give evidence or to produce documents or for both purposes on a specified date, time and place.

15. Service of summons or notice.—(1) Subject to the provisions of sub-rule (2) any notice, summons, process or order issued by the controlling authority may be served either personally or by registered post acknowledgement due or in any other manner as prescribed under the Code of Civil Procedure, 1908 (Act 5 of 19W.

(2) Where there are numerous persons as parties to any proceeding before the controlling authority and such persons are members of any trade union or association or are represented by an authorised person, the service of notice on the Secretary, or where there is no Secretary, on the principal officer of the trade union or association, or on the authorised person shall be deemed to be service on such persons.

16. Maintenance of records of cases by the controlling authority.—(T) The controlling authority shall record the particulars of each case under section V, in Form 'Q' and at the time of passing orders shall sign and date the particulars so recorded.

(2) The controlling authority shall, while passing orders in each case, also record the findings on the merits of the case and file it together with the memo- randa of evidence with the order sheet.

(3) Any record, other than a record of any order or direction, which is re- quired by these rules to be signed by the controlling authority, may be signed nn behalf of and under the direction of the controlling authority by any subordi- nate officer appointed in writing for this'purpose by the controlling authority.

17. Direction for payment of gratuity.—If a finding is recorded under sub-rule (4) of rule 11 that the applicant is entitled to payment of gratuity under the Act, the controlling authority shall issue a notice to the employer concerned in Form 'R' specifying the amount payable and directing payment thereof to the applicant under intimation to the controlling authority within thirty days from the date of receipt of the notice by the employer. A copy of the notice shall be endorsed to the applicant employee, nominee or legal heir, as the case may be,

18. Appeal.—(1) The Memorandum of appeal under sub-section (7) of section 7 of the Act shall be submitted to the appellate authority with a copy thereof tn the opposite party and the controlling authority either through delivery in person or under registered post acknowledgement due.

(2) The Memorandum of appeal shall contain the facts of the case, the decision of the controlling authority, the grounds of appeal and the relief sought.

(3) There shall be appended to the Memorandum of appeal a certified oopv of the finding of the controlling authority and direction for payment of gratuity.

(41 On receipt of the copy of Memorandum nf appeal, the controlling authority shall forward records of the ca^e to the appellate authority.

(5) Within 14 days of the receipt of the copy of the Memorandum of appeal, the opposite party ahall submit his comments on each paragraph of the memoran- dum with additional pleas, if any, to the appellate authority with a copy to the appellant.

(6) The appellate authority shall record its decision after giving the parties to the appeal a reasonable opportunity of being heard. A copy of the decision shall be given to the parties to the appeal and a copy thereof shall toe sent to the controlling authority returning his records of the cass.

(7) The controlling authority shall, on receipt of the decision of the appellate authority, make necessary entry in the records of the case maintained in Form 'Q¹ under sub-rule (1) of rule 16.

(8) On receipt of the decision of the appellate authority, the controlling authority shall. If required under that decision, modify his direction for payment of gratuity and issue a notice to the employer concerned in Form 'S' specifying the modified amount payable and directing payment thereof to the applicant, under intimation to the controlling authority within fifteen days of the receipt of the notice by the employer. A copy of the notice shall be endorsed to the applicant employee, nominee or legal heir, as the case may be and to the appel- late authority.

19, Application for recovery of gratuity.—Where an employer fails to pay the gratuity due under the Act in accordance with the notice by the controlling authority under rulo 17 or rule 18. as the case may be, the employee concerned, his nominee or legal heir, as th

20. Display of abstract of the Act and rules.—The employer shall display an abstract of the Act and the rules made thereunder in English and In the language understood by the majority of the employees at a conspicuous place at or near the main entrace of the establishment.

FoRM 'A'

[See sub-rule ( i) of rule 3]

Notice of Opening

1. Name and address of the Establishment

3. Name and designation of the Employer .

3. Number of persons employej

4. Maximum number of persons employed on any day during < he preceding twelve months with date,

5. N u m b er of employees covered by the Act.

d. Nature of Industry . . . ..

7. Whether Seasonal . . . ..

S. Date of opening . . . ..

9, Details of Head Office/branches. ,

fa) N a mc and Address of the Had Office . Number of employees (b) Names & addresses of other branches in

Tndia.

T,

2.

3.

I verify thai" the information furnished above is true to t"he best of my knowledge & belief.

Place

Signature of the Employer

with name and designation.

Date

To

The Controlling Authority

FORM 'B'

[Set sub-rule (2) of rule 3]

Notice of Change

Name and Address of the Establishment.

Take notice that following changes have taken place with effect from % in the particulars furnished by me In notice dated on Form A .

Name:—

AddrcBs:—

Name of the Employer .—

Nature of Business :—

Signature of the Employer with p ja ce

name and designation.

Date

To

The Controlling Authority,

[See sub-rule (3) of rule 3]

Notice of Closure

Take notice that it is intended to close down the establishment with effect from The other details are furnished below:—

r. Name & Address of the establishment

2. Name and address of the Head Office, if any.

3. Name & designation of the employer

4. Number of persons in employment

5. Number of employees entitled to gratuity

6. Amount of Gratuity involved.

Place

Signature of the Employer with name and designation.

LUte

The Controlling Authority,

[See sub-rule (i) of rule 5]

Notice for excluding husband from family

From—

1. Name of the female employee

2. Name or description of establishment vl""rs employed. . . . . ..

3. Post held with Ticket or Serial No., if any.

4. D-'pirtin.-'it/Branch/Seci'ion where employed .

5. Permanent address . . . ..

Take notice that I, Shrimati

desire to exclude my husband - from my family for the purposes of the Payment of Gratuity Act, Shri 1972,

Place

Signature/Thumb impression of the employee.

Date

Declaration by w'tficsscs

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

1.

i.

2.

2.

Place

Date

To

The Controlling Authority (through the employer) (Name and address of the employer here).

For me by the employer

Received and recorded in this establishment.

Reference No.

Signature of the employer or an officer authorised in this behalf by the employer.

Date

To

1. (employee)

2. The Controlling Authority.

NoiE.—Strike out the words not applicable.

[See sub-rule (2) of rule 5]

Notice of withdrawal of notice for excluding husband from family

1. Name of the female employee

2. Name or description of establishment whcie employed . . . . . ..

3. Post held with Ticket or Serial No., if any.

4. D.-pif'm-'iir/Bra:ich/Sfction where employed

5. Permanent address . . ..

Take noiic^ char I, Shrimati

,

, hereby withdraw the notice

from my family dated . . . .. . . whereby I excluded my husband Shri for the purposes of the Payment of Gratuity Act., 1972. The earlier noiii* vas record*if under your reference No dated

Place

Signature/Thumb impression of the employee-

Date

Declaration by witnesses

The above notice of withdrawal was signed/thumb impressed before mr

Name in full and full Signature of witnesses

address of witnesses

1.

f.

2.

2.

Place

Date

To

The Controlling Authority (through the employer) (Name and address of the employer).

For use by the employer

Received and recorded in this establishment.

Signature of the employer or Officer Reference No.

authorised.

Date

Seal or rubber etamp of the establishment.

To

r. (Employee'!

2. The Controlling Authority,

No i'E.—Strike out the words not applicable.

[SM aub-rule (i) a' rule fi]

Nomination

To

(Give here name or description of the establishment with full address).

I, Shri/Shrimati/Kumari

(name in full here)

whose particulars arc given in the statement below, hereby nominate the person(s) mentioned hckvw to receive thegratuity payable after my death as also the gratuitystnnd ngtomy" credit-nthe even' of my death before that amount has become payable, or having become payable has not been paid •nd direct that the s aid amount of gratuity shall be paid in proportion indicated agair the name(s) of the nominec(s).

2. I hereby cerUfy that the pcrson(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/mothcr/parents is/are not dependent on me.

(b) My husband's fathcr/mother/parcnts is/are not dependent on my husband.

5. I have excluded my husband from my family by a notice dated the to the ::o it rolling authority in terms of the proviso to clause (h) of section 2 of the said Act.

rt. Njniiiition TUii? herein inval'dates my previous nomination.

Nominee(s)

Name in full with full address of

Relation-

nominee(s)

Age of nominee

which will be

Proportion by the gratuity shared

ship with the employee

( 2)

(3)

CD

1.

2.

3-

soon.

Statement

s

1. Name of employee in full.

2. Sex

3. Religion

4. Whether unmarried/married/Widow/

widower. . . . ..

5. Department/Branch/Section where

employed

6. Poit held with Ticket or. Serial N o ., if any.

7. Date of appointment. . . ..

S. Permanent address . . ..

Village. Thana Subdivision.

Post Office District State

Place Date

Si [tilturc/Thjmb impression of the employee-

Declaration by witnesses

Nomination signed/thumb impressed before me.

Name in full and full address Signature of witnesses of witnesses

1.

1.

2.

2.

Place

Date

Certificate by the employer

Certified thatthe 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

Reaeivedthe duplicate copy of nomination in Form 'F' filed by me and duly ceitiftd ty tf e employer.

Signature of the employee

Date

NoLc.— Strike out the worda/peragraph not applicable.

[See sub-rule (,3) of rule 6]

Fresh Nomination

To

(G Ve here rume or de ,or pPon of the establishment with full address,) I,Shr/Shrraati

vhose particular;, are

(Name in full here)

given m the statement helow, have acquired a family w.th'nthemean ngotcluvste ih;of sect'on(2,j of the Payment of Gratuity Act, T972 w,th effect from the • (date here) 'n the mann r indicated below and t her/fore nowmate a fresh the pcrsun(V mentioned below \o receive the giaiin \ payable after my death as also the gratuity stand ng 10 mj ciedii 11 tl e eveni of my death bet'oie that amount has become payable, or having become payable has not heen pa;d and d rect Iha1 the sad amount ot gratuity shall be pad in propoition ndicatee ugaistift i.tnils ol tH- nominee^s).

2. I hereby certify the person(s)nominuled it H/aicmcmberfs)ofni> fnni'ly w ih ntKrncanng of clause (h) of sect, on 2 of the 6a d Act.

3. (a) Mv father/nother/pfltents is/me not dependent on me.

(b) My husband's father/mother/parenTs s/are not dependent on my husband,

4. I have excluded my husband from my family by anoticedated the .

tothe controlling authority In terms of the prov 1,0 to clBi-'e (h) of Sect on ol t?c fa d.

Nomitiee(s)

N-iu^'n full v;th full address of

nom;ntefs)

Relation-

sh'P w th

Age of nominee

Proportion by which rho gratuity will be shared

the. employee

( 1)

(3)

(4)

1.

2,

3-

So on

Manner of acquiring a "family"

(H;rc g've details as to how a family was acquired, i.e., whether by marriage or parents being rendered dependent or through 01 htr prnccit like adoption),

Statement

I. Name of the employee in full

2. Sex

Religion

3.

Whether unmarried/ married/ widov/ widuwcr

4-

Department/ Branch/ Section where

5.

employed

Post held with Ticket No. or Serial No,, if any

6.

Date of appointment

7-

Permanent address

8.

Village Post (Me-

Than a Uishlct

Subdivision State

Place

Sign at ure/thum,b impression of the employee.

Date

Declaration hy witnesses

Fresh nomination signed/ thumb impressed before me.

Name In full and full addresses Signature of witnesses of witnesses

I

2

i

P l a c e . . ..

2

D a le

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 Date Design ation-

Name and address of the establishment or lubber stamp

thereof.

Acknowledgment by the employee

Received the duplicate copy of the nomination in form filed by me on duly certified by the employer.

Dati'

Signature of the employee.

NoTl! :—Strike out wordt, and paragraphs nol applicable.

FORM 'H1

[See sub-rule (4) of rule 6]

Modification of nomination

To

(Give here name or description of the establishment with full address)

t. Shri/ Shrimati/ Kumari

(Name in full here)

whose particulars are given in the statement below, hereby give notice that the nomination filed by me on and recorded under your reference

(date)

No dated shall stand modified in the following manner :—

(Here give details of the modifications intended)

Statement

1. Name of the employee in full

2. Sex

3. Religion

4. Whether unmarried/ married/ widow/widower

5. Department/ Branch/ Section where employed

6. Post held with Ticket No. or Serial No.,

if any

7. Date of appointment

8. Address In full

Signature/ thumb impression of the employee.

Place

Date

Declaration by witnesses

Modification of nomination signed/ thumb impressed before me.

Signature of witnesses Name in full and address of witnesses

1

1

2

2

Place..., ..

Date

Certificate by the employer

Certified that the above modifications have been recorded.

Employer's reference No., Signature of the employer/ officer authorised if any,

Designation

Date , Name and address of the establishment or

rubber stamp thereof.

Acknowledgement by the employee

Reccivcdthc duplicate copy of the notice for modification in Form H filed by me on

duly certified by the employer.

Date

Signature of the employee.

NOTE :—Strike out the words not applicable.

[See sub-rule (i) of rule 7]

Application for gratuity by an employe*

To

(Give here name or description of the establishment with full "ddie&<,)

Sir/ Gentlemen,

I beg to apply for payment of gratuity to which l am entitled under sub-section (1) of section 4 of the Payment of Gratuity Act, 1972 on account of my superannuation/ reiiremant/resignation after completion of not less than five years of (.omtincus service/ totaldisablement due to accident/ total disablement dw to disease with cflcct frcm tht- Necesaary particulars relating to my appointment in the establishment are given in the Statement below.

Statement

1. Name in full

2. Address in full

3. Department/ Branch/ Section where last

employed

4. Post held with Ticket No. or Serial No

if any

5. Dale of appointment

6. Date and cause of termination of service

7. Total period of service

8. Amount of wages last drawn

9. Amount of gratuity claimed

2. I was rendered totally disabled as s result of

(here give the details of the nature of disease or accident)

The evidences/witnesses In support of my total disablement are as follows :—

( Here give details ).

3. Payment may please be made in cash/open or crossed bank cheque,

4, Aa the amount of gratuity payable is less than Rupees one thousand, I shall request you to arrange for payment of the sum due to me by postal Money Order at the idclress mentioned above after deducting postal money order commission therefrom.

Yours faithfully.

Signature/Thumb impression ot the Placf :

applicant employee, Date :

NOTE :~

(1) Stride out the words not applicable. (2) Strick out paragraph or paragraphs not applicable.

[Se" sub-rule (2) of rule 7]

Application for gratuity by a nomitu*

To

(Give here the name ot description of the establishment with full address).

Sir/Gentlemen,

I beg to apply for payment of gratuity to which I am entitled under sub-8cction (1), of section 4

(name of the employee)

of the Payment of Gratuity Act, 1972 as a nominee of Late

,

who was an employee of your

establishment and died on

the The gratuity is payable on account of the death of the aforesaid employee

while in service/superannuation of the aforesaid employee on /retirement or reiig-

nation of the aforesaid employee on after completion of years of *ervice/lota]

disablement of the aforesaid employee due to accident or disease while in service with effect from

he Nscisaftry particulars relating to my claim are given in the statement below.

Statement

1. Name of applicant nominee . . ..

2. Address in full of the applicant nominee

3. Marital status of the applicant nominee

(Unmarrled/married/widow/widower)

A. Name in full of the employee

5. Martial status of employee

6. Relationship of the nominee with the employee

7. Total piriod of service of the employee

8. Date of appointment of the employee .

9. Date and cause of termination of service of the

employee . . , . . ,.

10. Dcpartment/Branch/Scction where the em-

ployee last worked . . . ..

11. Post last held by the employee withTicket or

Serial N o ., if any

12. Total wages Ia3t drawn by the employee

13. Date of death and evidence/witness as proof

of death of the employee . . ..

14. Reference N o. of recorded nomination if

available . . . . . ..

15. Total gratuity payable to the employees

16. Share of gratuity claimed . . ..

2. I declare that the particulars mentioned in the above Statement are true and correct to t he

best of my knowledge and belief.

3. Payment may please be made in cash/crossed or open bank cheque.

4. As the amount payable is less than Rupees one thousand, I shall request you to an lange for payment of the sum due to me by postal Money Order at the address mentioned above after de- ducting postal money order commission thereform.

Yours faithfully, Signature/Thumb, impression of

applicant nominee.

Placc_:

Date :

NOTB.—(l) Strike out the words not applicable.

(2) Strike out the paragraph or paragraphs not applicable,

[Sea sub-rule (3) 0/ rule 7]

Application for gratuity by a legal htir

To

{Give here Ihc iiumc or description ol the establishment with full address)

Sic/fr.'iUjemen,

I beg to apply for payment of gratuity to which I am entitled under sub-section (1), of section 4 of the Payment of Gratuity Act- 1972 as a legal heir of Jate

(Name of the amploycc) who was an employee of your establishment and died on the without mating any nomination. The gratuity is payable on account of the death of the aforesaid employee while in service/superaiumation oi the afoiesaid cmplojtc on the retirement or resignation of the aforesaid ernplo) ce on the after completion of years of scrvicc/tota] disablemer.1 of the aforesaid cniployee due to accident or deseasc while in service with effect from the . Necessary particulars relating to my claim are given in the Statement below.

Statement

T . Name of applicant legal heir

2. Address in full of applicant legal heir .

3. Marital status of the applicant legal heir (unmarried/married/widoW/widower)

4. Name in full of the employee

5. Relationship of the applicant with the em- ployee . . . . . ..

' 6, Religion of both the applicant and the em- ployee . . . . . ..

7, Date of appointment and total period of service

of the employee . . . ..

4. Uepaument/Branch/Section where the em-

ployee worked last . . . ..

9. Post last held by the employee with Ticket or

Serial No., if any.

ro. Total wages lai>t drawn by the employee

11. Date and cause of termination of service of the

employee (death or otherwise)

12. Date of death of the employee and evidence/ witness in support thereof . . ..

13. Total gratuity payable to the employee .

J 4. Percentage of the gratuity claimed

15. Basis of the dnim and evidence/witness in support thereof. . . . ..

2. I declare that the parilc"inrs mentioned in the above Statement are true and correct t o t hc best of my knowledge and belief.

3. Payment may please be made in cash/open or crossed bank cheque,

4. As the amount payable is less than Rupees one thousand, I shall request you to arrange foi payment of the sum due to me by postal Money Order at the address mentioned above, after de- ducting postal money order commission therefrom.

Yours faithfully,

Signature/Thumb Impression of applicant legal heir.

Place:

Date:

NOTE:—Strike out the words not applicable.

[ See clause (i) of sub-rule (1) of rule 8]

Notice for payment of gratuity

To

(Name and address of the applicant employee/nominee lrgal heir\

You are hereby in formed as required under clause (i) of sub-rule (1) of rule 8 of the Payment of Gratuity (Central) Rules, 1973 that a sum of Rs (Rupees is payable to you as gratuity/as your share of gratuityin terms ofnomination made by on , and recorded in this

as, a legal heir of

an employee of this

, establishment/

2. Please call at

on

(Here specify place)

(date) at for collecting your payment in cash/open or crc>i",td chcque.

(time)

3. Amount payable shall be sent To you by postal Monty Order at the address givt n in yinr application after deducting the postal money order commission. HS desi] cd by you, by

Brief statement of calculnticr.

1. Total period of service of the employee concerned:—

i Years months.

2. Wages last drawn :

3. Proportion of the admissible gratuity payable in tetms of nr>rninetiori/"s a l(t'"l rio'r:

4. Amount payable:

Signature of the employer/Authorised Officer Place:

Date:

Name or description of establishment or rubber stamp thereof.

Copy to the Controlling Authority.

JSTOTK:—Strike out the words not applicable.

[S"* clause (ii) of sub-rule (i) of rule 8]

Notice rejecting claim for payment of gratuity

To

(Name and address of the applicant employee/nominee legal heir).

You are hereby informed as required under clause (ii) of sub-rule (i) of rule 8 of the Payment of Gratuity (Central) Rules, 1972 that your claim for payments of gratuity as indicated on yo\;r application In Form . . .. under the said rules is not admissible for the reasons stated below

Reasons

(Here specify the reasons)

Place :

Signature of the employer/ Authorised Officer.

Date:

Name or description of establishment

or rubber stamp there of.

Copy to the Controlling Authority.

NJTB.—Strike out the words not applicable.

FORM 'N'

[See sub-rule (1) of rule 10]

Application for direction

Before the Controlling Authority under the Payment of Gratuity Ar.f, 107:.

Application Dale

BETWEEN

(Name in full of the npplicnnt with full address")

A ND

(Name in full of the employer concerned with full address)

The applicant is an employee of the above-mentioned cmployer/a nominee of late in employee of the above -mentioned employer/a lpgal heir of late in employee of the above-mentioned employer, and h entitled to payment of gratuity under section 4 of the Payment of Gratuity Act, 1972 on account of his own /aforesaid employee's superanu- allon on

/his own retirement/aforsaid employees' resignation

(date)

on after completion of years of continuous service/his own/aforesaid (dare)

employees' total disablement with effect from ., ..(date) due to accident/desease death of aforesaid employee on

2. The applicant submitted an application under rule of the Payment of Gratuity Act, 1972 but the above-mentioned employer refused to entertain on the it Issued anotice dated the under caluse of sub-rule of role offering an amount of gratuity which is less than my due/issued a notice dated the under clause of sub-rule of rule rejecting my eligibility tt> payrnenj or gratuity. The duplicate copy of the said notice is enclosed.

3. The applicant submits that there is a dispute on the matter (specify the disputed.

4. The applicant furnishes the necessary particulars in the annexure hereto and prays that the Controlling Authority may be plaeased to determine the amount of gratuity payable to the petitioner and direct the above -mentioned employer to peythe same to the petitioner.

5. The applicant declares that the particulars furnished in the annexure hereto are true and correct to the best of his knowledge and belief.

D"te—

ANNBXURE

1. Name in full of applicant with full address

2. Basis of claim

(Death/Superannuation/Retircment/Resignation/Disableinent of employee-)

Nam* and address in full of the employee

3-

Marital status, of the employee unmarried /

4-

married /widow/wid ower)

Name and address in full of the employer

5-

6. Department/Branch/Section where the em- ployee was last employed (if known)

7- Post held by the employee with Ticket or serial No., if any

(if known)

Date of applotntment of the employee

s;

(if known)

9-

Date and cause of termination of service of the employee (superannuation / retirement / regignation /disablement/death).

Total period of service by the employee.

to.

Wages last drawn by the employee

I I.

If the employee is dead, date and cause thereof

12.

13-

Evidence/witness in support of death of the employee

If a nominee, No. and date of recording of

14.

nomination with the employer.

Evidence/witness in support of being al*|jal

t5-

heir if a legal heir.

16. Total gratuity payable to the employee (if known)

T7.

Percentage of gratuity payable to the applicant as nominee/legal heir

Amount of ftrafuity claimed by the applicant.

rR.

Signature/Thumb impreanion of the applican P l a c e-

Date—

NOTE.—Strike out the words not applicable.

[See sub-rule (i") of rule u]

Notictfor appearance before the contTolling authority.

From : The Controlling Authority under the Payment of Gratuity Actj 1972.

To

(Name and address of the employer/applicant)

Whereas Shri—

, an employee under you/a nominee(s) legal heirfs) of Shri an employee under the above-mentioned employer, has/have filed an application under sub-rule (1) of rule 10 of the Payment of Gratuity (Central) Rules , 1972 alleging that—

[A copy of the said application is enclosed]

Now, therefore , you arc hereby called upon to appear before me at either personally or through a person duly (place) authorised in this behalf for the purpose of answering all material questions relating to the application on the day of 19 at V clock in the forenoon/ afternoon in support of / to answer the allegation : ; and as the day fixed for your appearance is appointed for final disposal of the application, you must be prepared to produce on that day all the witness upon whose evidence, and the documents upon which you ntend to rely in support of your allegation/defence.

Take notice that in default of your appearance r>n the day before mentioned the application will be dismissed/hcared and determined in your absence.

Given under my hand and seal, this day of 19

Controlling Authority.

NOTE : Strick out the word* and parajraph not applicable.

[Ser rule 14]

Summons

Bfore the Controlling Authority under the Payment of Gratuity ACT, 1972

To

("Name and address 1

Whereas your attendance is required to give evidence/you are required to produce the docu- ments mentioned in the list below, on behalf of

in the case arising out of the claim for gratuity by

from.

and referred to this Authority by an application under Section 7. of the Payment of Gratuity Act, IQ72. you are hereby summoned to appear personally before this Authority on the day of—19 at O' clock in the forenoon/afternoon and to bring with you (or to send to this Authority (ire s

List of Documents

1.

3.

3, soon

Controlling Authority.

Dated this day of 19

NOTE.— (1) The portion not applicstble to be deleted.

(2) The summons shall be Issued in duplicate. The duplicate is to be signed and returned by the person served before th date fixed.

(3) In case the summons is issued only for producing a document and not to give eviden ce it will be sufficient compliance to the summons if the documents are caused to be produced before the controlling authority on the day and hour fixed for the purpose.

[See Sub-rule (i) of rule 16]

Particular:: ol application under section

1. SerialNo.

2. Date of the application

3. Name and address of the applicant

4.. Name and address of the employer

5. Amount of gratuity claimed

6. Dates of hearing

7. Findings with date

8. Amount awarded

9. Cost, if any, awarded.

io-. Dire of notice issued for payment of gratuity

11. Date of appeal, if any

12. Decision of the appellate authority

13. Date of Issue of Final Notice for payment of

gratuity

i_). Date of Payment of Gratuity by Employer

with mode of payment

15. Date of Receipt of- application for recov iv

of Gratuity

16. Date of Issue of Recovery Certificate

17. Date of recovery

18. Other remarks

19. Signed

20. Date

(5"ruleI7J

Notice for payment of gratuity

To

(Nome and address of employer)

Wherea§ Shri/Smtf/Kunttri

of

, , an employee (address)

an. employee under you/a.inoraaiee(*)/lcgal heir(g) oflatc under you, tiled an application under sec. 7 of the Payment of Gratuity Act, 1972 before me;

Ani whereas the applcitiqn was heard ti your presence on and after the hearing I have come is entitled to as gratuity under the to the finding that the said Shri/Smt./Kumari a payment of Rs Payment of Gratuity Act, 1972;

Nr.v, therefore, I hereby direct to pay the said sutito! Rs to Shri /Smt./ Kumar w.thin thirty days of the receipt o this notica with an intimation thereof to me.

Given under my hand and seal3 this day of 19 .

Controlling Authority,

Copy to

(Applicant under rule )

He ii adviied to contact t h; employer for collecting payment.

NOTE.—-The portion not applicable to be deleted.

[See Sub-rule (5) of rule 18]

Notice for Payment of Gratuity as dtUnnintd by Apptllatt Authority

To

(N"me "nd address of employer)

Whereas a notice wag given to you on form 'R'requiring you to make a payment as gratuity under of Rs to Shri/Smf./Kumari the Payment of Gratuity Act., 1972;

Whereas you /the applicant went in appeal belore the appellate authority, who has decided that an amount of R3 is due to be paid to Shri/Smt./Kumari.. , as gratuity due under the Payment of Gratuity Act, 1972;

Mow, therefore, I hereby direct you to pay the said sum ot Rs

to Shri/Smt./Kumari , within 30 days of the receipt of this notice with an intimation thereof to me.

Given under my hand andscal, this day of . . .. 19 .

Controlling Authority.

Copy to

I. The Applicant.

He is advised to contact the employer for collecting pajicent .

2. The Appellate Authority.

Mote:—The portion not appHcabl; to be deleted.

(Sec rule 19 )

Application for recovery of gratuity

4;''orj rh~ Co-itrolling Authority under the Payment of Gratuity Act, 1972.

ilicationNo. Date

Between

(N'm.- 'n full of th; applicant with address)

And

(Name in fullof the employer with full address)

The ipiUji'xr '5 in employee of the above-mentioned e'uployer/a nom nee of late

an employee of the above-mentioned employer/a legal heir of late ., an employee of the above-mentioned em- ployer, and yn'i w.-rt pl-issi to direct the said employer in your notice dated the , under rule . . of th;Piy-nstitof Gratuity (Central) Rules, 1972 for payment of aBurn of Rs. • as gratuity payable under the Payment of Gratuity Act, 1972.

2. The applicant submits that the said employer failed to pay the said amount of gratuity to me as directed by you although I approached him for payment.

3. The appl'Cint therefore prays that a c:i lificatc may be issued under section ... , ol said fh-Act lor rccoveryo'the saidsutn of Rs dueto m J 83 gratuity in terms of your direction.

Signiture/Thumb impression of the applicanc.

Place :

Date :

NOTE :—Strike out the words not applicable

[No. S. 70020 (3)/72-PF. Il-(ii)]

D. S. NIM, Jt. Secy.

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