Notice for excluding husband from family from
1. Name of the female employee.
2. Name or description of establishment where employed. 3. Post held with Ticket or Serial No., if any. 4. Department/Branch/Section where employed. 5. Permanent address. Take notice that I, Shrimati desire to exclude my husband Shri from my family for the purposes of the Payment of Gratuity Act, 1972. Place Signature/Thumb impression Date of the employee. Declaration by witnesses The above notice was signed/thumb impressed before me. Name in full and full Signature of witnesses. address of witnesses. 1. 1.
2. 2. Place
Date
To
The Controlling Authority.
(Through the employer)
[Name and addrtss of the employer here] For use by the employer Received and recorded in this establishment. Date Signature of the employer or an officer authorised in this behalf by the employer Reference No. To
(Employee)
2. The Controlling Authority.
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