Notice of withdrawal of notice for exduding husband from family 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 hereby withdraw the notice dated whereby I exclude my husband Shri from my family for the purposes of the Payment of Gratuity Act, 1972. The earlier notice was recorded under your reference No dated Place Signature/Thumb impression Date of the employee. Declaration by witnesses The above notice of withdrawal 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 address of the employer] For use by the employer Received and recorded in this establishment. Reference No. Signature of the employer or Date V officer authorised.
Seal or rubber stamp of the establishment.
To (Employee)
2. The Controlling Authority. * Forms D and E have become redundant as rule 5 of these Rules have become redundant because of proviso to sub-clause (ii) of clause (h) of section 2 of the Payment of Gratuity Act, 1872 has been omitted by the Payment of Gratuity (Amendment) Act, 1987 (22 of 1987), sec. 2 (w.e.f. 1-10-1987), Ed.
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