FORM II
[See sub-rule (4) of rule 31
FRESH NOMINATION

To
(Give here name and address of employer together with name and full address of the establishment).
I.................................................................................................................
(name in full here)
whose particulars are given in the statement below have acquired a family within the meaning of Cl. (e) of rule 2 with effect from …………… (date here) ………………..in the manner indicated below and therefore nominate a-fresh the person mentioned to receive all amounts payable to me as wages, if such amounts could not' or cannot be a paid on account of my death before the payment or on account of my whereabouts not being known.
2. 1 hereby certify that the person nominated by me is a member of my family within the meaning of Cl. (e) of rule 2.
3. (a) My father/mother/parents is/are not dependent on my husband.

Nominee
Name and address of the nominee	Nominee’s relationship with the employed person	Age of Nominee
1	2	3
	Manner of acquiring a “Family”

(Here give details as to how a family was acquired, i.e. whether by marriage or parents being rendered dependent or through other mode like adoption)
Statement
1. Name of the employed person in full:
2. Sex
3. Religion:
4. Whether unmarried/married/widow/widower:
5. Department/Branch/Section where employed
6. Post held with ticket number of serial number, if any:
7. Date of appointment:
8. Present address:
9. Permanent address:
Village………………..Thana………. Sub-Division………… Post Office……… District ……….. State…………..
Place……………
Date…………..
Signature/thumb-impression
of the employed person
Declaration by witnesses.
 Fresh nomination signed/thumb-impressioned before me.
Signature of witnesses
Name in full and address
1                                                                      1
2                                                                      2                     
Place………..
Date……….
(Certificate by the employer)
Certified that the particulars of the above nomination have been verified and recorded in register in nominations in Form IV at serial number………………
Signature of the employer/
Officer authorised.
Designation.
Name and address of the
establishment or rubber stamp thereof.
Place……….
Date………..
Acknowledgment of the employed person
Received the duplicate copy of the nomination in Form 11 filed by me and duly certified by the employer.
Signature of the employed person
Place………..
Date………..
Note: Strike out the words and paragraph not applicable.