POWER GRID CORPORATION OF INDIA LTD.

“Saudamini”
Plot No. 02, Sector – 29,
Gurgaon – 122001 (Haryana)
EMPLOYEES GRATUITY FUND TRUST
(For office use only)
Account No…………..
FORM – “A”
FORM OF AGREEMENT
I hereby declare that I have read the rules and regulations of Power Grid Corporation Employee’s Gratuity
Fund and that I agree to be bound by them and by subsequent additions and/or alterations if any, to them
from time made in pursuance of the Rules and Regulations of the Fund.

1. Name : _______________________________________________________________________________________________

(Surname) (First Name) (Middle Name)

2. Age : _______________________________________________________________________________________________

(Years) (Months)

3. Date of Birth : __________________________________________________________________________________________

4. Religion : __________________________________________________________________________________________

5. Sex : __________________________________________________________________________________________

6. Father’s/Guardian’s Name : _______________________________________________________________________________

7. Marital Status : _______________________________________________________________________________________

8. Husband’s/Wife’s Name : ________________________________________________________________________________

9. Identification Mark : ____________________________________________________________________________________

10. Division/Office in which working : __________________________________________________________________________

11. Designation : ______________________________________________________________________________________________

12. Employee Number : _____________________________________________________________________________________

13. Date of Appointment : ___________________________________________________________________________________

14. Permanent Address : ______________________________________________________________________________________

15. Present Address : _________________________________________________________________________________________

Tel. No. ________________________

Tel No. _____________________
Place : _______ __________________

Date : ________ _________________

Signature/ thumb impression of

the employee
Certified that the above declaration has been executed by ………………….. Emp.

No……………………………..employed as ……………………… at ………………………………………

before me after he/she had read the entries.

Place:……………………
Date:…………………….

Signature of the

Controlling Officer
 FORM ‘B’

POWERGRID EMPLOYEES GRATUITY FUND

NOMINATION

Para (i) of Rule 32

To,

The Secretary,
Board of Trustees
Power Grid Corporation of India Ltd
Employees Gratuity Fund
Gurgaon-122001.
Sir,

1 I Shri/Shrimati/Kumari _____________________________ Employee No __________ of

_____________________ (name of the sub-station)hereby nominate the person(s) mentioned below to
receive the gratuity payable after my death as also the gratuity standing to my credit in the event
of my death before the amount has become payable , or having become payable has not been paid
,and direct that the said amount of gratuity shall be paid in the proportion indicated against the
name(s) of the nominee(s)
2 I Hereby certify that the person(s) mentioned is/are a member(s) of my family within the meaning
of Explanation 1 to Rule 32 of the Rules and Regulation
3 I hereby declare that I have no family within the meaning of Explanation 1 to Rule 32 of the Rules
and Regulations.
4 a) My father/mother /parents is /are not dependent on me.
b) My husband’s father /mother /parents is/are not dependant on my husband.

5 I have excluded my husband from the family by a notice dated ____________________to the
secretary in terms of proviso to Explanation-I (ii) to Rule 32 of the Rules and Regulations.
6 Nomination made herein invalidates my previous nomination(s).
 Nominee(s)
Sl.No. Name in full with full Relationship with Age of nominee Proportion by
address of nominee(s) the employee which Gratuity
will be shared
1
2
3
4
So on

Place___________________ Signature/Thumb impression

Date___________________ of the employee

Declaration by witnesses

Nomination signed/Thumb

impressed before me

Name and address, in full, of witnesses Signature of Witnesses

1. 1.

2. 2.

Date ______________

Place _____________