Contingencies on the happening of which the nomination shall become invalid Signature of the member of the Service.

Transcription

1 SCHEDULE D/E/F/G Nomination for death-cum-retirement Gratuity When the member of the Service has a family and wishes to nominate one member / more than one member of family* or has no family* and wishes to nominate one person / more than one person* thereof I hereby nominate the person mentioned below who is a member of my family*/not a member of my family* and confer on him the right to receive any death-cum-retirement gratuity that may be sanctioned by State Government in the event of death while in service and the right to receive on my death, any gratuity which having become admissible to me on retirement may remain unpaid at my death. Name and address of nominee Relationship with the member of the Service Amount or share of gratuity payable to each Contingencies on the happening of which the nomination shall Name, 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 predeceasing the member of the Service or the nominee dying after the death of the member of the Service but before receiving payment of the gratuity. Amount of share+ of gratuity payable to each nominee @ This nomination supersedes the nomination made by me earlier on. which stands cancelled. Dated this.day of 20 at. Witnesses to signature : Signature of the member of the Service. N.B.- The officer should draw lines across blank space below the last entry to prevent the insertion of any name after he has signed. 1. The nomination made by the member of service, who has no family at the time of making a nomination, shall in the event of the member of the Service subsequently acquiring a This column should be filled in so as to cover the whole amount of gratuity. + The amount/share of gratuity shown in column 7 should cover the whole amount/share payable to the original nominees. * Strike off whichever is not applicable.

2 SCHEDULE H Nomination for Family Pension I hereby nominate the persons mentioned below, who are members of my family, to receive, in the order shown below, the family pension which may be granted by State Government in the event of my death after completion of 10 years qualifying service. Name and address of nominee Relationship with the Whether married or unmarried member of Service This nomination supersedes the nomination made by me earlier on.. Which stands cancelled. Dated this.day of 20 at. Witnesses to signature: Signature of the member of the Service. N.B.- The officer should draw lines across blank space below the last entry to prevent the insertion of any name after he has signed.

3 SCHEDULE J Details of Family : [See rule 22(11)(a)(i)] Name of the member of service Designation Date of birth Date of appointment Details of my family as on Serial Name of the members of No. family 1 Date of birth Relationship with the officer Initial of the Head of Office Remarks I hereby undertake to keep the above particulars up-to-date by notifying to the Head of the Office any addition or alternation. Place: Date: Signature of the Member of Service * Family for this purpose means family as defined in clause (b) of sub-rule (20) of rule 22 of the All India Services (Death-Cum- Retirement Benefits) Amended Rules, NOTE. - Wife and husband shall include respectively judicially separated wife and husband

4 Form No. 7 / 8 Nomination for benefits under the Central Government Employees Group Insurance Scheme, 1980 When the Government servant has a family* and wishes to nominate one member or more than one member / or, has no family* and wishes to nominate one person or more than one person thereof. I, hereby nominate the person(s) mentioned below who is/are member(s) of my family * or I having no family* hereby nominate the following person/persons, and confer on him/them the right to receive to the extent specified below any amount that may be sanctioned by the Central Government under the Central Government Employees Group Insurance Scheme, 1980 in the event of my death while in service or which having become payable on my attaining the age of superannuation may remain unpaid at my death. Sr No. Name and address of Nominee Relationship with Government servant Share of Amount to be paid to each Contingencies on the happening of which the nomination shall Name, address of the person or persons if any to whom the right of the nominee shall pass in the event of his predeceasing the subscriber Dated the.day of 20.. at Two witness to signature Signature of Government servant. N.B. The Government servant should draw line across the blank space below his last entry to prevent the insertion of any names after he has signed. 1. Column No. 5 should be filled in so as to cover the whole amount that may be payable under the Insurance Scheme. 2. Where a Government servant who has no family makes a nomination, he shall specify in column no. 6 that the nomination shall become invalid in the event of his subsequently acquiring a family. * strike off whichever is not applicable

5 FORM I / II /III / IV Nomination for All India Service Provident Fund [Rule 4(3)] When the subscriber has a family and wishes to nominate one member*/ more than one member*, or *, has no family and wishes to nominate one person* /more than one person* thereof- I hereby nominate the person/persons mentioned below, who is/are member/s of my family as defined in rule 2 of the All India Service (Provident Fund) Rules, 1955, or, I, having no family* as defined in rule 2 of the All India Services (Provident Fund) Rules, 1955, hereby nominate the person/persons mentioned below to receive the amount that may stand to my credit in the Fund, in the event of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount shall be distributed among the said persons in the manner shown below against their names : Name and address of nominees Relationship with subscriber Amount or share of accumulation to be paid to each Contingencies on the happening of which the nomination shall Name, address of the person or persons if any to whom the right of the nominee shall pass in the event of his predeceasing the subscriber Dated this day of 20.. at. Two witnesses to signature 1. 2 Signature of the Subscriber. * strike of whichever is not applicable Note :- 1. Column No. 4 should be filled in so as to cover the whole amount that may be payable under the AIS provident fund.