See Sub-Rule (1) of Rule 6

T.N. PAYMENT OF GRATUITY RULES, 1973

FORM ‘F’ {See sub-rule (1) of Rule 6}

Nomination / Re nomination (please tick whichever is applicable)

To, Cavinkare Pvt Ltd “CavinVille”, 12, Cenotaph Road Teynampet, Chennai 600 018

1. Thiru / Thirumathi / Selvi ……………………………..(Employee No:………..) Whose particulars are given in the statement below, hereby nominee the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity standing to my credit in the events of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against the name (s) of the nominee(s).

2. I hereby certify that the person(s) mentioned is / are member (s) of my family within the meaning of clause (h) of section 2 of the Payment of Gratuity Act,1972.

Nominees

Name in full with Relationship with Age of nominee Proportion by which full address of the employee the gratuity will be nominee’s shared Statement

1. Name of the employee & address in full :

2. Employee No. :

3. Date of Joining :

4. Department :

5. Sex :

6. Religion :

7. Marital Status :

Place:

Date: Signature of the employee

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

Date: Signature of the employer/officer Authorised Designation

Name and address of the Establishment or Rubber-stamp