[HEADER — replace with your organisation’s letterhead, if used]
Gratuity Nomination
Nomination for payment of gratuity
Collect this from every employee at induction and refresh it whenever family circumstances change. Where an employee dies without a nomination on file, gratuity is payable to the legal heirs, which means the family must establish succession at the worst possible time. A form completed on day one avoids that entirely.
[COMPANY NAME] [ADDRESS OF THE ESTABLISHMENT]
Establishment registration: [NUMBER]
To the Employer
I, whose particulars are given below, hereby nominate the person or persons named below to receive the gratuity payable in respect of my employment in the event of my death, and direct that it be paid in the proportions stated.
1. Particulars of the Employee
| Item | Detail |
|---|
| Full name | [NAME] |
| [Son / daughter / wife of] | [NAME] |
| Employee identification number | [ID] |
| Designation and department | [DESIGNATION], [DEPARTMENT] |
| Date of birth | [DATE] |
| Date of joining | [DATE] |
| Permanent account number | [PAN] |
| Marital status | [Married / Unmarried] |
| Permanent address | [ADDRESS] |
| Present address | [ADDRESS] |
| Place of work | [LOCATION] |
2. Nominees
Nomination must be made in favour of a member of the family, where the employee has a family. A nomination in favour of a person who is not a family member is void where the employee has a family at the time of nomination.
| # | Name of nominee | Relationship | Date of birth | Full address | Share of gratuity (%) |
|---|
| 1 | [NAME] | [RELATIONSHIP] | [DATE] | [ADDRESS] | [%] |
| 2 | [NAME] | [RELATIONSHIP] | [DATE] | [ADDRESS] | [%] |
| 3 | [NAME] | [RELATIONSHIP] | [DATE] | [ADDRESS] | [%] |
| 4 | [NAME] | [RELATIONSHIP] | [DATE] | [ADDRESS] | [%] |
| Total | | | | 100% |