Form XIII

[See clause (a), (b), (c), (d), (e) of sub-rule (2) of rule 53 ]

Notice for payment/rejecting claim of Gratuity

(strike out the words not applicable)

To,

………………………………..

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

1. You are here by informed that,-

a. *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 53, a sum of Rs.

……….. (Rupees .................only) 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; or

1.

b. *as required under sub-clause (ii) of clause (a) of sub-rule (2) of rule 53, that your claim for payment of

gratuity, as indicated on your application in Form-XII under the said rules, is not admissible for the

reasons stated below:(here specify the reason).

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:

3.

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/

authorized officer

Name or description of the establishment or

rubber stamp their of

Copy to:

1. The Competent Authority,...................... (in case of denial of gratuity)

2. Office of the Director General, Labour Bureau, Ministry of Labour and Employment, Chandigarh.