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Form F - Nomination - POG Act
Form F - Nomination - POG Act
[See s u b -r u le(1 ) of r u le 6 ]
No m in at io n
To,
Vedantu Innovations Pvt. Ltd.
D. No. 1081, 3rd Floor,
Vistar Arcade, 14th Main Rd,
Sector 3, HSR Layout
Bangalore, Karnataka, India-560102
Devarsh Patel
I, S h r i ......................................wh os e p a r ticu la r s a re given in th e
s t a tem en t b elow,
4. (a ) My fa t h er / m ot h er / p a ren t s is / a r e n ot d ep en d a n t on m e.
(b ) m y h u s b a n d ’s fa t h er/ m ot h er / p a ren t s is / a r e n ot d ep en d a n t on m y
h u sban d.
5. I h a ve exclu d ed m y h u s b a n d fr om m y fa m ily b y a n ot ice d a te t h e …… to
t h e con t rollin g a u t h or it y in ter m s of t h e p r ovis o t o cla u s e (h ) of s ect ion 2
of t h e s a id Act .
No m in e e (S )
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S t at e m e n t
1. Na m e of em p loyee in fu ll Devarsh Patel
2. Sex. Male
3. Religion . Hindu
4. Wh et h er u n m a r r ied / m a r r ied / wid ow/ wid ower . Unmarried
5. Dep a r t m en t / Br a n ch / Section wh ere em p loyed .
6. Pos t h eld with Tick et or S er ia l No., if a n y.
7. Da te of a p p oin t m en t .
8. Per m a n en t a d d res s .
Villa ge… … … … … … ..Th a n a … … … … … … … .S u b -d ivis ion … Vastral
Ramol Vastral
… … … … … Pos t Office…
District...Ahmedabad.. State...Gujarat..
Pla ce Ahmedabad, GJ,IN S ign a tu re/ Th u m b im p r es s ion
Da te September 22, 2022 of t h e em p loyee
Pla ce Ahmedabad
Da te September 22, 2022
S ign a tu re of t h e em p loyer /
Officer a u th orized
Da te Na m e a n d a d d r es s of t h e
E s t a b lis h m en t or r u b b er s t a m p
t h ereof.
Da te S ign a tu re of t h e em p loyee
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