FORM NO. 40B
[See rule 67A/rule 101A]*
Form for modifying nomination
……………. [name of fund] Provident Fund/………..[name of fund] Gratuity Fund *
Account No…………………
I,……………….., hereby cancel the nomination made by me previously as regards the disposal of the * amount that may stand to my credit in the provident fund/ * amount of gratuity in the event of my death and hereby nominate the person(s) mentioned below to receive the * amount that may stand to my credit in the provident fund/ * amount of gratuity in the event of my death before that amount becomes payable, or having become payable, has not been paid, and direct that the said amount shall be distributed among the said person(s) in the manner shown against their names :
Name and address of nominee or nominees |
Nominee's relationship with the employee |
Age of nominee |
* Amount or share of accumulations in the provident fund/ * amount or share of gratuity to be paid to each nominee † |
1 |
2 |
3 |
4 |
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* 1. Certified that I have no family and should I acquire a family hereafter, the above nomination should be deemed as cancelled.
* 2. Certified that my father/mother/sister(s)/minor brother(s) is/are dependent upon me.
Dated this……………day of………………at …………………
Two witnesses to signature
1…………………. Signature of employee
2…………………..
Certified that the above declaration has been signed before me by Shri/Shrimati
Date…………………
Signature of the trustee or any
person authorised by the
trustees in this behalf
*Delete the inapplicable words.
†This column should be filled in so as to cover the whole of the amount that may stand to the credit of the employee in the provident fund or the whole of the amount of gratuity that may be payable in the event of his death.
