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    Payment of Wages Nomination Form

    Uploaded by

    Kiran Kumar N
    1. The document is a nomination and declaration form for an employee to nominate beneficiaries to receive any amounts due in the event of the employee's death. 2. It requests information such as the employee's name, address, date of birth, sex, marital status, and dependent parents. 3. The employee nominates beneficiaries including their name, address, relationship, date of birth, and share of accumulated amounts to be received.

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    Payment of Wages Nomination Form

    Uploaded by

    Kiran Kumar N
    28 views1 page
    1. The document is a nomination and declaration form for an employee to nominate beneficiaries to receive any amounts due in the event of the employee's death. 2. It requests information such as the employee's name, address, date of birth, sex, marital status, and dependent parents. 3. The employee nominates beneficiaries including their name, address, relationship, date of birth, and share of accumulated amounts to be received.

    Original Description:

    Form 1

    Original Title

    534243950-Payment-of-Wages-Nomination-Form (1)

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    1. The document is a nomination and declaration form for an employee to nominate beneficiaries to receive any amounts due in the event of the employee's death. 2. It requests information such as the employee's name, address, date of birth, sex, marital status, and dependent parents. 3. The employee nominates beneficiaries including their name, address, relationship, date of birth, and share of accumulated amounts to be received.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    28 views1 page

    Payment of Wages Nomination Form

    Uploaded by

    Kiran Kumar N
    1. The document is a nomination and declaration form for an employee to nominate beneficiaries to receive any amounts due in the event of the employee's death. 2. It requests information such as the employee's name, address, date of birth, sex, marital status, and dependent parents. 3. The employee nominates beneficiaries including their name, address, relationship, date of birth, and share of accumulated amounts to be received.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Form-I Employee No.

    _______________

    NOMINATION AND DECLARATION FORM (Mandatory)

    [See Rule 3]

    1. Name of person making nomination (in block letters) __________________________________________________

    2. Father’s/Husband’s Name________________________________________________________________________

    3. Date of Birth ___________________________________________________________________________________

    4. Sex ___________________________________________________________________________________________

    5. Marital Status __________________________________________________________________________________

    6. Address:

    Permanent _____________________________________________________________________________________

    Present ________________________________________________________________________________________

    I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the person(s) mentioned
    below to receive any amount due to me from the employer, in the event of my death.

    Total amount If the nominee is


    of share of minor,name,realtionship
    accumulations and address of guardian
    Nominee's in credit to be who may receive the
    Name of the relationship with paid to each amount during the minority
    nominee/ nominees Address the member Date of Birth nominee of nominee
    (1) (2) (3) (4) (5) (6)

    Children details can be


    mentioned if required

    < Total % of share should be 100% >

    1. Certified that I have no family and should I acquire a family hereafter, the above nomination shall be deemed as
    cancelled.
    2. Certified that my *father/mother is/are dependent upon me.

    *Strike out whichever is not applicable < Employee Signature >


    Signature or the thumb impression of
    the employed person.
    CERTIFICATE BY EMPLOYER

    Certified that the above declaration and nomination has been signed/thumb impressed before me by
    Shri/Smt/Kum____________________________employed in my establishment after he/she has read the entry/entries
    have been read over to him/her by me and got confirmed by him/her.

    Signature of the employer or other authorized

    Officer of the establishment and Designation


    Place _________________
    Date _________________ Infosys Limited,
    No.44, Electronics city,
    Hosur Road,
    Bangalore- 560 100

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