The Payment of Gratuity (Central) Rules, 1972
*FORM 'E'
[See sub-rule (2) of rule 5]
Notice of Withdrawal of Notice for Excluding Husband from Family
1. Name ofthe female employee.
2. Name or description of establishment where employed.
3. Post held with Ticket or Serial No., if any.
4. Department/Branch/Section where employed.
5. Permanent address.
Take notice that I, Shrimati ..................... hereby withdraw the notice dated whereby .................. I exclude my husband Shri ................... from my family for the purposes of the Payment of Gratuity Act, 1972. The earlier notice was recorded under your reference No .................. dated ................
| Place | Signature/Thumb impression Date of the employee. |
Declaration by witnesses
The above notice of withdrawal was signed/thumb impressed before me.
| Name in full and full address of witnesses. |
Signature of witnesses. |
| 1. | 1. |
| 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.
| Reference No. Date | Signature of the employer or |
To
1. ....................(Employee)
2. The Controlling Authority.
*Ed. - Form D and E have became redundant as rule 5 of these Rules have became redundant because of proviso to sub-clause (i i) of clause (h) of section 2 of the Payment of Gratuity Act, 1972 has been omitted by the Payment of Gratuity Act, 1987 (22 of 1987), sec. 2 (w.e.f. I. I 0.1987).
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