Form "'

(Seo sub-rulo (1)of rule 7)

Appllcatlon for Gratulty by an employee
To,
M/s. Asian Palnts (U) LId.
6A, Shantiaagar,
Santacruz (E),
Mumbai . 400 055

Sirls,
4 of the Payment of
lbeg to apply for payment ol gratuity to which Iam entitled under sub-seotion (1) ol section
Gratuity Act, 1972 on account of my superannuation/retiremenUreslgnation after compeion of not less than
due to disease with ellect
.five years of continuous servicetotal disablement due to accidentotal disablement
trom Necessary particulars rolating to my appointment In the estabishment aro given in
the sialement below.
STATEMENT

(1) 1. Name in full

2.

3. DepartmentBranch/Secllon where last employd. Project Sale.

Post held and Employee code. Executve -2
Date of appointment - 01-2olí.
6 Dato andcause of termination of service I-oR-2o23
serviceed 7moths
7. Total period ol
8 Amouni of salary last drawn

Amount of graluity claimed

(2) Iwas rendered tolally disabied as a result of

(Here give the details of the nature of the dissase or acçident)

The evidences/witnesses in support of my total disublement aro a follows:

(Here give details)

cheque/Demand Drat.
(3) Payment may please be made by cash/open or crossed bank

Yours faithiuly.

Place Nar wana