FORM I

[See sub-Rule (1) of Rule 7]

APPLICATION FOR GRATUITY BY AN EMPLOYEE

 

To

  

 

Sir/Gentlemen,

 

            I beg to apply for payment of gratuity to which I am entitled under sub-section (1) of Section 4 of the Payment of Gratuity Act, 1972 on account of my Superannuation/ retirement/ resignation after completion of not less than five years of continuous service total disablement due to accident/total disablement due to disease with effect from the ____________________ Necessary particulars relating to my appointment in the Establishment are given in the statement below:

 

STATEMENT

 

1.      Name in full

2.      Address in full

3.      Department/ Branch/ Section where employed

4.      Post held with Ticket or Serial No. if any

5.      Date of appointment

6.      Date and cause of termination of service

7.      Total period of service

8.      Amount of wages last drawn

9.      Amount of gratuity claimed

   

2. I was rendered totally disabled as a result of ________________________________.


3. Payment may please be made in cash/ open or crossed Bank Cheque.

4. As the amount of gratuity payable is less than Rupees One Thousand. I shall request you to arrange for payment of the sum due to me by

     Postal Money Order at the address mentioned above after deducting Postal Money Order commission there from.

 

 

Yours faithfully,

 

 

Place:                                                                                                                              Signature/ Thumb-impression

Date :                                                                                                                               of the applicant-employee      

 




Different types of forms of gratuity

Form Name Use of Form
Gratuity Form I
Application for the payment of gratuity
Gratuity Form J Used by the nominee to make application for payment of gratuity
Gratuity Form K Used by legal heir to make application for the payment of gratuity
Gratuity Form F To make nomination
Gratuity Form G To make fresh nomination
Gratuity Form H Modification of nomination
Gratuity Form L Issued by the employer to employee stating amount and date of payment
Gratuity Form M Issued by the employer stating the reason for the rejection of gratuity
Gratuity Form N Application made to the labour commissioner by an employee
Gratuity Form 0 Issued by the authority to appear for case hearing
Gratuity Form P Summons issued by the authority to be present for hearing
Gratuity Form R Issued by the authority directing to make gratuity payment