FORM OF NOMINATION
[See Rule 5 (3)]
Account No.
I, , hereby nominate the person(s) mentioned below who is/are member(s)/non member(s) of my family as defined in Rule 2 of the General Provident Fund (Central Services) Rules,1960 to receive the amount that may stand to my credit in the fund as indicated below, in the event of my death before that amount has become payable or having become payable has not been paid.
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Name
and full address of the nominee(s)
1 |
Relationship
with the subscriber
2 |
Age
of the nominee(s)
3 |
Share
payable to each nominee
4 |
Contingencies
on the happening of which nomination will become
invalid
5 |
Name,
Address and relationship of the person(s) if any to whom the right of
nominee shall pass in the event of his/her predeceasing the
subscriber
6 |
If
the nominee is not a member of the family as provided in Rule 2, indicate
the reasons.
7 |
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Dated this
. Day of
20
..
at
.
Signature of the
subscriber
..
Name in Block
letters
Designation
Two witnesses to
signature
Name
and Address
Signature
1.
2.
Nomination by Shri/Smt/Kumari
,
Designation
Date of receipt of
nomination
Signature of Head of Office/ PAO
Designation
Date
.