Form VIII

[(See Rule 20(2)(i) (a) and rule 20 (2)(i) (b)]

Notice for Payment/Rejecting claim of Gratuity

(Strike out the words not applicable)

To,……………………………………………………………………………

(Name and address of the applicant employee/nominee legal heir)

You are hereby informed that

(a) *as required under sub-clause (ii) of clause (a) of sub-rule (2) of rule 35 of the Code on

Social Security (Central) Rules, 2020, that your claim for payments of gratuity as indicated on

your application in Form-IV under the said rules is not admissible for the reasons stated below:

Reasons (Here specify the reasons); or

(b) *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 35 the Code on

Social Security (Central) Rules, 2020 that a sum of Rs. ………..(Rupees…………………) is

payable to you as gratuity/as your share of gratuity in terms of nomination made by

………………..on …………………and……………recorded in this

…………………as a legal heir of an employee of this establishment.

2. *Please call at ……………………..on…………………………

(Here specify place)……………………..(date) at……………….(time) for collecting

your payment of gratuity crossed cheque.

3. Amount payable shall be sent to you through demand draft or shall be credited in your

bank account as desired by you.

4. Brief statement of calculation

(a) Date of appointment.

(b) Date of termination/superannuation/resignation/ disablement/death.

(c) Total period of service of the employee concerned:……. years… …….. months.

(d) Wages last drawn:

(e) Proportion of the admissible gratuity payable in terms of nomination/as a legal

heir:

(f) Amount payable:

*strike out para, if, not applicable

Place:

Date: Signature of the Employer/authorised officer.

LGP.Kvt.M-2819/03-26/10

Name or description of establishment or rubber stamp

thereof.

Copy to: The Competent Authority in case of denial of gratuity.

Copy also to: Office of DG Labour Bureau, Ministry of Labour and Employment, Chandigarh.