Form XVI

{See sub-rule (7) of Rule 55}

Notice for Payment of Gratuity as determined by Competent/Appellate Authority

(Strike out the words not applicable)

To,

………………………………….

(Name and address of employer)

1. Whereas Shri/Smt./Kumari.......................................... of an employee ........................... (address)

under you/a nominee(s)/legal heir(s) of late................................................................. an employee

under you, filed an application under section 56 of the Code on Social Security, 2020, before me; or whereas

a notice was given to you on .........................requiring you to make payment of Rs........................ to

Shri/Smt./Kumari....................................as gratuity under the Code on Social Security, 2020;

and whereas, the application was heard in your presence/ ex-parte on............. and after the hearing have come

to the finding that the said Shri/Smt./ Kumari............................................ is entitled to a payment

of Rs..................... as gratuity under the Code on Social Security, 2020; or whereas you/the applicant went in

appeal before the appellate authority, who has decided that an amount of Rs....................... is due to be paid

to Shri/Smt./Kumari................ as gratuity due under the Code on Social Security, 2020.

Now, therefore, I hereby direct you to pay the said sum of Rs........... to Shri/Smt./Kumari...................................

within thirty days of the receipt of this notice with an intimation

thereof to me.

Given under my hand and seal, this ................day of...................20............

Competent Authority under the

Code on Social Security Code, 2020

Copy to:

1. The Applicant......................... with a advise to contact the employer for collecting payment.

2. The Appellate Authority,..................................... (if applicable).

Note: Strike out paragraphs if not applicable.