Notice for Payment of Gratuity as determined by Appellate Authority

Form ‘S’
[See sub-rule (5) of rule 18]

(Name and address of employer)

Whereas a notice was given to you on ……………… in Form ‘R’ requiring you to make a payment of Rs. ………………. to Shri/Shrimati/Kumari ………………. as gratuity under the Payment of Gratuity Act, 1972.

Whereas you/the applicant went in appeal before the appellate authority, who has decided that an amount of Rs. …………… is due to be paid to Shri/Shrimati/Kumari ………………….. as gratuity due under the Payment of Gratuity Act, 1972;

Now, therefore, I hereby direct you to pay the said sum of Rs. …………….. to Shri/Shrimati/Kumari …………… within …….. days of the receipt of this notice with an intimation thereof to me.

Given under my hand and seal, this …………………. day of ……… 20………

Controlling Authority
Copy to :

1. The applicant.
He is advised to contact the employer for collecting payment.

2. The Appellate Authority.

Note - The portion not applicable to be deleted.