FORM 'F'

See sub rule(1) of Rule 6

Gratuity Nomination Form

To: TATA Consultancy Services Ltd. 9th Floor, Nirmal Building, Nariman Point, Mumbai - 400021.

These details are picked from GRS -> Gratuity Nomination Form link and displayed here.

I, Khanolkar, Mr. Santosh Gopal whose particulars are given in the statement below, hereby nominate the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity standing to my credit in the event of my death before that amount has become payable, or having become payable has not been paid and direct that the said amount of gratuity shall be paid in proportion indicated against the name(s) of the nominee(s). 2. I hereby certify that the person(s) nominated is/are a member(s) of my family within the meaning of clause (h) of Section 2 of the Payment of Gratuity Act,1972. - Yes 3. 4. I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the said Act. - No (a) My father is not dependent on me. - Yes (b) My mother is not dependent on me. - Yes (c) My spouse's father is not dependent on my spouse. - Yes (d) My spouse's mother is not dependent on my spouse. - Yes 5. I have excluded my husband from my family by a notice dated the provison to clause (h) of Section 2 of the said Act. 6. - No to the controlling authority in terms of the

Nomination made herein invalidates my previous nomination. - Yes

Nominee details entered in GRS Gratuity Fund Nomination table are displayed here.

Nominee(s)
Relationship with the Employee Date of Birth Proportion Name , Relationship and by which Address of Guardian if Nominee Gratuity will is minor be shared 100 NA

Sr.No Name in full with full Address of Nominee(s)

1.

Ms. Neha Santosh Khanolkar B-10, The Dadar CHSL, Sharadashram, Bhavani Shankar Road, Opp. Sharadashram school, Mumbai, Mumbai City, Maharashtra, India 400028

Spouse

10/09/1977

Family, in relation to an employee, shall be deemed to consist of: 1. in the case of a male employee, his wife, his children, whether married or unmarried, his dependent parents & dependent parent - in laws and children of his predeceased son, if any. in the case of a female employee, her husband, her children, whether married or unmarried, her dependent parents & dependent parent - in laws and children of her predeceased son, if any. Nomination made by such employee in favour of a person who is not a member of his family, shall be void
1

2.

3.

These details are picked from Application Link

Statement
Full Name: Sex: Marital Status: Religion: Permanent Address: Khanolkar, Mr. Santosh Gopal Male Married Hindu B/10, THE DADAR CHSL, SHARADASHRAM, BHAVANI SHANKAR ROAD, DADAR (WEST), MUMBAI, Maharashtra, India - 400028 Employee Number: Date of joining: Department: Computer Consultancy

Date: Place:

Enter the date and place, when you sign the Form
Enter the date, when you sign the Form.

Sign here on the printout

Signature of the Employee

Signatures of two witnesses are required here. Any of your two colleagues can sign and also enter the date and place.
Sr.No 1. 2.

Declaration by Witnesses
Nomination signed before me

Name in full with full address of Witnesses

Signature of Witnesses

Date:

Place:

Certificate by the Employer

Certified that the particulars of the above nominations have been verified and recorded in this establishment

Do not sign here

Office Seal Signature of the Employer/Trustee

Acknowledgement by the Employee

Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.

Enter the date, when you sign the Form

Date:

Sign here on the printout

Signature of the Employee