Notice Of Excluding Husband From Family 137 - Legal Draft

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Category : Notices

Notice of Excluding Husband from Family

Form ‘D’
[See sub-rule (1) of rule 5]

From .....................

1. Name of the 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 ...................... desire to exclude my husband Shri ................ from my family for the purposes of the Payment of Gratuity Act, 1972.

Place :........
Date :.........

Signature/Thumb Impression of the employee.

Declaration by witnesses

The above notice 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 here)

For use by the employer

Received and recorded in this establishment

Date : ..........

Signature of the employer or
An officer authorized in this
Behalf by the employer.

To

1. ........................... (Employee)
2. The Controlling Authority

Note.- Strike out the words not applicable.