Any regular government employee under central government of India who are cover under General Provident Fund has to submit nomination for Death-cum-Retirement Gratuity or otherwise known as DCRG in the prescribed FORM No.1 or FFORM No.2 .
Here Form 1 is meant for employee who have family and wishes to nominate one or more member of his family member as the benefecieries .
Format of the the Required Form is as hereunder:
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Here Form 1 is meant for employee who have family and wishes to nominate one or more member of his family member as the benefecieries .
Format of the the Required Form is as hereunder:
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FORM NO. 1
[See rule 53(1)]
Nomination for Death-cum-Retirement Gratuity when the Govt. servant has family and wishesnominate one member for more than on member thereof.
I……………………………………………………hereby nominate the person/persons mentioned below
who is / are member (s) of my family and confer on him/them the right to receive to the extent specified
below, any gratuity that may be sanctioned by the Central Govt. in the event of my death while in
service and the right to receive on my death, to the extent specified below any gratuity which having
become admissible to me on retirement may remain un-paid at my death,
Name and address of nominees/ nominee | Relationship With Govt. servant | Age | Amount of share of gratuity payable to each* | Name and address, relationship and age of the person /or persons, if any to whom the nominee shall pass in the event of nominee predeceasing the Govt. servant but before Receiving payment of gratuity | Amount ofshare of gratuity payable to each** |
1 | 2 | 3 | 4 | 5 | 6 |
* This column should be filled in so as to cover the whole amount of gratuity.
** The amount/share of the gratuity shown in this column should cover the whole
amount / share payable to the original nominee (s).
This nomination supersedes the nomination made by me earlier on……… which stand
cancelled.
Note . (1) The Govt. servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he has signed.
(2) Strike out which is not applicable.
Dated this ………day of …………… at…………………………….
Witnesses to sign here: --
1………………………………………
2………………………………………
(TO BE FILLED IN BY THE HEAD OF OFFICE/ACCOUNTS OFFICER)
Nomination by ………………………………………
Designation ………………………………………….
Office……………………………………………….. Signature of Head of Office/ Accounts Officer
Designation ..........................................
Dated ..................................................
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FORM NO. 2
[See rule 53(1)]
Nomination for Death-cum-Retirement Gratuity when the Govt. servant has no family and wishes to
nominate one person or more than on person.
I,…………………………having no family, hereby nominate in person/persons mentioned below
and confer on him/them the right to receive to the extent specified below any gratuity that may be
sanctioned by the H.P. Govt. in the event of my death while in service and the right to receive on my
death, to the extent specified below any gratuity which having become admissible to me on
retirement may remain unpaid at my death.
| ORIGINAL NOMINEE (S) | ALTERNATE NOMINEE (S) | ||||
| Name and address of nominees/ nominee | Relation | Age | Amount of share* | Name and address, relationship and age of the person /or persons, if any to whom the right conferred on the nominee predeceasing the Govt. servant but before receiving payment of gratuity | Amount of share of gratuity payable to each** |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
* This column should be filled in so as to cover the whole amount of gratuity.
** The amount/share of the gratuity shown in this column should cover the whole
amount / share payable to the original nominee (s).
This nomination supersedes the nomination made by me earlier on………
which stand cancelled.
Note. (1) The Govt. servant shall draw lines across the blank space below the last entry
to prevent the insertion of any name after he has signed.
(2) Strike out which is not applicable.
Dated this ………………… day of ………………….at…………………………….
Witnesses to sign here: --
1………………………………………
2………………………………………
3………………………………………
Signature of Applicant.
(TO BE FILLED IN BY THE HEAD OF OFFICE/ACCOUNTS OFFICER)
Nomination by ………………………………………
Designation ………………………………………….
Office………………………………………………..
Signature of Head of Office/Accounts Officer
Dated……………………….
Designation…………………
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