Gopal Rai
Form A- Notice of opening
Form 0- Notice for appearance before the controlling authority
Form B- Notice of change
Form C- Notice of closure
Form D- Notice for excluding husband from family
Form E- notice of withdrawal of notice for excluding 27 husband from family
Form F- Nomination
Form G- Fresh Nomination
Form H- Modification of nomination
Form I- Application of gratuity by an employee
Form J- Application for gratuity by a nominee
Form K- Application for gratuity by a legal heir
Form L- Notice for payment of gratuity
Form M- Notice rejecting claim for payment of gratuity
Form N- Application for direction
Form P- Summons
Form Q- Particulars of application under section 7
Form R- Notice for payment of gratuity
Form S- Notice for payment of gratuity as determined by Appellate Authority
Form T- Application for recovery of gratuity
Form U- Abstract of the Act and Rules
Form 'I'- Application of gratuity by an employee

[See sub-rule (1) of rule 7]
Application of gratuity by an employee
[Give here name or description of the establishment with full address]
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:
1. Name in full.
2. Address in full
3. Department/Branch/Section where last employed.
4. Post held with Ticket No. or Serial No., if any.
5. Date of appointment.
6. Date cause of termination of service.
7. Total period of service.
8. Amount of wages last claimed.
9. Amount of gratuity claimed.
I was rendered totally disabled as a result of
[Here give the detail of the nature of disease or accident]
The evidence/witnesses in support of my total disablement are as follows:
[Here give Detail]
Payment may please be made in cash/open or crossed bank Cheque.
As the amount of gratuity payable is less than Rupees one thousand, I shall request you to arrange for payment of the sum to me by Postal Money Order at the address mentioned above after deducting postal money order commission therefrom.
    Yours faithfully,
Place   Signature/Thumb impression of
Date   the applicant employee.
Strike out the words not applicable.
Strike out paragraph or paragraphs not applicable.
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Last Updated : 23 Mar,2014
Contact for Help/Grievance Redressal | Vacancy | Messages|RTI Act 2005