Rajasthan Payment of Gratuity Rules, 1973 1. Short title and Commencement. 2. Definitions. 3. Notice of opening, change or closure of the establishment. 4. Display of notice. 5. Form of notice under proviso to section 2 (h) (ii). 6. Nominations. 7. Application for gratuity. 8. Notice for payment of gratuity. 9. Mode of payment of gratuity. 10. Application to controlling authority for direction. 11. Procedure for dealing with application for direction. 12. Place and time of hearing. 13. Administration of oath. 14. Summoning and attendance of witnesses. 15. Service of summons or notice. 16. Maintenance of records of cases by the controlling authority. 17. Direction for payment of gratuity. 18. Appeal. 19. Application for recovery of gratuity. 20. Display of abstract of the Act and rules.

Rajasthan Payment of Gratuity Rules, 1973

Published vide Notification No. GSR 99/F. 1 (2). (68) Sharm/72. dated 8-5-1973, published in Rajasthan Gazette, Part 4-C, sub-Part (1), Extra ordinary, dated 22-5-1973.

RJ177

In exercise of the powers conferred by sub-section (1) of Section 15 of the Payment of Gratuity Act, 1972 (Central Act 39 of 1972), the State Government hereby makes the following rules, namely: -

Short title and Commencement.- (1) These Rules may be called the Rajasthan Payment of Gratuity Rules, 1973.

(2) These Rules shall come into force at once.

Definitions.- In these Rules, unless there is anything repugnant in the subject or context:-

(a) "Act" means the Payment of Gratuity Act, 1972;

(b) "Appellate authority" means the State Government or the authority specified by the State Government under sub-section (7) of Section 7 of the Act;

(d) "Nomination" means nomination made under Section 6;

(e) "Section" means a Section of the Act.

Notice of opening, change or closure of the establishment.- (1) Within thirty days of the rules be coming applicable to an establishment, a notice in Form "A" shall be submitted by the employer to the controlling authority of the area.

(2) A notice in Form "B" shall be submitted by the employer to the controlling authority of the area within thirty days of any change in the name, address, employer or nature of business.

(3) Where an employer intends to close down the business shall submit a notice in Form "C" to the controlling authority of the area at least sixty days before the intended closure.

Display of notice.- (1) The employer shall display conspicuously a notice at or near the main entrance of the establishment in Bold Letters in English and in a Language understood by the majority of the employees specifying the name of the officer with designation authorised by the employer to receive on his behalf notices, under the Act or the rules.

(2) A fresh notice shall be displayed immediately after the notice referred to in sub-rule (1) becomes illegible or requires a change.

Form of notice under proviso to section 2 (h) (ii).- (1) A Notice under the proviso to sub-clause (ii) of clause (h) of Section 2 of the Act shall be in Form "D" and sent in triplicate by the employee to the employer who shall, after recording its receipt on one copy thereof, return the copy to the employee and send the second copy to the controlling authority of the area.

(2) An employee may withdraw the notice referred to in sub-rule (1) by giving another notice in triplicate in Form "E", to the employer, who shall follow the same procedure as in sub-rule (1).

Nominations.- (1) A nomination in Form "F" shall be submitted in duplicate by personal service by the employee, after taking proper receipt or by sending through registered post acknowledgement due to the employer-

(i) in the case of an employee who is already in employment for a year or more on the date of commencement of these Rules, ordinarily within ninety days from such date; and

(ii) in the case of an employee who complete one year of service after the date of commencement of these Rules ordinarily within thirty days of the completion of one year of service:

Provided that nomination in Form "F" shall be accepted by the employer after the specified period, if it is filed with reasonable grounds for delay, and no nomination so accepted shall be invalid merely be cause it was filed after the specified period.

(2) Within thirty days of the receipt a nomination in Form "F" under sub-rule (i), the employer shall get the service particulars of the employee, as mentioned in the form of nomination, verified with reference to the records of the establishment and return to the employee, after obtaining a receipt thereof, the duplicate copy of the nomination in Form "F" duly attested either by the employer or an officer authorised in this behalf by him, as a token of recording of the nomination by the employer and the other copy of the nomination shall be recorded.

(3) An employee who has no family at the time of making a nomination shall, within ninety days of requiring a family submit in the manner specified in sub-rule (1), a fresh nomination as required under sub-section (4) of Section 6, in duplicate in Form "G" to the employer, and thereafter the provisions of sub-rule (2) shall apply mutatis mutandis if it was made under sub-rule (1).

(4) A notice of modification of a nomination including cases where a nominee predeceases an employee shall be submitted in duplicate in Form "H" to the employer in the manner specified in sub-rule (1) and thereafter the provisions of sub-rule (2) shall apply mutatis mutandis if it was made under sub-rule (1).

(5) A nomination or a fresh nomination or a notice of modification of nomination shall be signed by the employee or, if illiterate, shall bear his thumb impression, in the presence of two witnesses who shall also sign a declaration to that effect in the nomination fresh nomination or notice of modification of nomination, as the case may be.

(6) A nomination, fresh nomination or notice of modification of nomination shall take effect from the date of receipt thereof by the employer.

Application for gratuity.- (1) An employee who is eligible for payment of gratuity under the Act, or any person authorised in writing, to act on his behalf, shall apply, ordinarily within thirty days from the date of the gratuity became payable, in Form "1" to the employer:

Provided that where the date of superannuation or retirement of an employee is known the employee shall apply to the employer before thirty days of the date of superannuation or retirement.

(2) A nomination of an employee who is eligible for payment of gratuity under the second proviso to sub-section (1) of Section 4 of the Act shall apply ordinarily within thirty days from the date of the gratuity became payable to him in Form "J" to the employer:

Provided that an application in plain paper with relevant particulars shall also be accepted. The employer may obtain such other particulars as may be deemed necessary by him.

(3) A legal heir of an employee who is eligibly for payment of gratuity under the second proviso to sub-section (1) of section 4 shall apply ordinarily within one year from the date the gratuity became payable to him, in Form "K" to the employer.

(4) Where gratuity becomes payable under the Act before the commencement of these Rules, the period of limitation specified in sub-rules (1), (2) and (3) shall be deemed to be operative from the date of such commencement.

(5) An application for payment of gratuity filed after the expiry of the periods specified in this rule shall also be entertained by the employer, if the applicant adduces sufficient cause for the delays in preferring his claim and no claim for gratuity under the Act shall be invalid merely because the claimant failed to present his application within the specified period. Any dispute in this regard shall be referred to the controlling authority for his decision.

(6) An application under this rule shall be presented to the employer either by personal service or by registered post acknowledgment due.

Notice for payment of gratuity.- (1) Within fifteen days of the receipt of an application under Rule 7 for payment of gratuity, the employer shall-

(i) if the claim is found admissible on verification issue a notice in Form "L" to the applicant employee, nominee or legal heir, as the case may be specifying the amount of gratuity payable and fixing a date, not being later than the thirtieth day after the date of receipt of the application, for payment thereof, or

(ii) if the claim for gratuity is not found admissible, issue a notice in Form "M" to the applicant employee, nominee or legal heir as the case may be specifying the reasons why the claim for gratuity is not considered admissible.

In either case a copy of the notice shall be endorsed to the controlling authority.

(2) In case payment of gratuity is due to be made in the employer's office, the date fixed for the purpose in the notice in Form "L" under clause (i) of sub-rule (1) shall be re-fixed by the employer, if a written application in this behalf is made by the payee explaining why it is not possible for him to be present in person on the date specified.

(3) If the claimant for gratuity is nominee or a legal heir, the employer may ask for such witness or evidence as may be deemed relevant for establishing his identity or maintainability of his claim as specified for issuance of notices under sub-rule (1) shall be operative with effect from the date such witness or evidence as the case may be called for by the employer is furnished to the employer.

(4) A notice in Form "L" or Form "M" shall be served on the applicant either by personal service after taking receipt or by registered post with acknowledgement due.

(5) A notice under sub-section (2) of Section 7 shall be in Form "L".

Mode of payment of gratuity.- The gratuity payable under the Act shall be paid in cash or, if so desired by the payee in Demand Draft or Bank Cheque to the eligible employee, nominee or legal heir, as the case may be:

Provided that in the case the eligible employee, nominee or legal heir as the case may be, so desires and the amount of gratuity payable is less than one thousand rupees, payment may be made by postal money order after deducting the postal money order commission therefor from the amount payable:

Provided further that intimation about the details of payment shall also be given by the employer to the controlling authority of the area.

Application to controlling authority for direction.- (1) If an employer-

(i) refuses to accept a nomination or to entertain an application sought to be filed under Rule 7, or

(ii) issues a notice under sub-rule (1) of Rule 8 either specifying an amount of gratuity which is considered by the applicant less than what is payable or rejecting eligibility to payment of gratuity, or

(iii) having received an application under Rule 7 fails to issue any notice as required under Rule 8 within the time specified therein, the claimant employee, nominee or legal heir, as the case may be, may, within ninety days of the occurrence of the cause for the application, apply in Form "NT to the controlling authority for issuing a direction under sub-section (4) of Section 7 with as many extra copies as are the opposite party:

Provided that the controlling authority may accept any application under this sub-rule, on sufficient cause being shown by the applicant after the expiry of the specified period.

(2) Application under sub-rule (1) and other documents relevant to such an application shall be presented in person to the controlling authority or shall be sent by registered post acknowledgement due.

Procedure for dealing with application for direction.- On receipt of an application under Rule 10 the controlling authority shall, by issuing a notice in Form "O" call, upon the applicant as well as the employer to appear before him on a specified date, time and place, either by himself or through his authorised representative together with all relevant documents and witnesses, if any.

(2) Any person desiring to act on behalf of an employer or employee, nominee or legal heir, as the case may be, shall present to the controlling authority a letter of authority from the employer or the person concerned, as the case may be, on whose behalf he seeks to act together with a written statement explaining his interest in the matter and praying for permission so to act. The controlling authority shall record thereon an order either according his approval or specifying in the case of refusal to grant the permission prayed for, the reasons for the refusal.

(3) A party appearing by an authorised representative shall be bound by the acts of the representative.

(4) After completion of hearing on the date fixed under sub-rule (1), or after such further evidence, examination of documents witnesses, hearing and enquiry as may be deemed necessary the Controlling authority shall record his finding as to whether any amount is payable to the applicant under the Act. A copy of the finding shall be given to each of the parties.

(5) If the employer concerned fails to appear on the specified date of hearing after due service of notice without sufficient cause, the controlling authority may proceed to hear and determine the application exparte. If the applicant fails to appear on the specified date of hearing without sufficient cause, the controlling authority may dismiss the application:

Provided that an order under this sub-rule may on good cause being shown within thirty days of the said order, be reviewed and the application reheard after giving not less than 'fourteen days' notice to the opposite party of the date fixed for rehearing of the application.

Place and time of hearing.- The sittings of the controlling authority shall be held at such times and at such places as he may fix and he shall inform the parties of the same in such manner as he thinks fit.
Administration of oath.- The controlling authority may authorise a clerk of his office to administer oaths for the purpose of making affidavits.
Summoning and attendance of witnesses.- The controlling authority may, at any stage of the proceedings before him, either upon or without an application by any of the parties involved in the proceedings before him, and on such terms as may appear to the controlling authority, just issue summons to any person in Form "P" either to give evidence or to produce documents or for both purposes on a specified date, time and place.
Service of summons or notice.- (1) Subject to the provisions of sub-rule (2) any notice, summons process or order issued by the controlling authority may be served either personally or by registered post acknowledgement due or in any other manner as prescribed under the Code of Civil Procedure, 1908 (Central Act 5 of 1908).

(2) Where there are numerous persons as parties to any proceeding before the controlling authority and such persons are members of any trade union or association or are represented by an authorised person, the service of notice on the Secretary or where there is no Secretary, on the principal officer of the trade union or association, or on the authorised person shall be deemed to be service on such persons.

Maintenance of records of cases by the controlling authority.- The controlling authority shall record the particulars of each case under Section 7, in Form "Q" and at the time of passing orders shall sign and date the particulars so recorded.

(2) The Controlling Authority shall, while passing orders in each case, also record the findings on the merits of the case and file it together with the memoranda of evidence with the order-sheet.

(3) Any record, other than a record of any order or direction, which is required by these Rules to be signed by the controlling authority, may be signed on behalf of and under the direction of the controlling authority by any subordinate officer appointed in writing for this purpose by the Controlling Authority.

Direction for payment of gratuity.- If a findings is recorded under sub-rule (4) of Rule 11 that the applicant is entitled to payment of gratuity under the Act, the Controlling Authority shall issue a notice to the employer concerned in Form "R" specifying the amount payable and directing payment there of to the applicant under intimation to the controlling authority within thirty days from the date of receipt of the notice by the employer. A copy of the notice shall be endorsed to the applicant employee, nominee or legal heir, as the case may be.
Appeal.- (1) The Memorandum of appeal under sub-section (7) of Section 7 of the Act shall be submitted to the appellate authority with a copy thereof to the opposite party and the controlling authority either through delivery in person or under registered post acknowledgement due.

(2) The Memorandum of appeal shall contain the facts of the cases, the decision of the controlling authority, the grounds of appeal and the relief sought.

(3) There shall be appended to the Memorandum of appeal a certificate copy of the finding of the controlling authority and direction for payment of gratuity.

(4) On receipt of the copy of Memorandum of appeal the controlling authority shall forward records of the case to the appellate authority.

(5) Within 4 days of the receipt of the copy of the Memorandum of appeal, the opposite party shall submit his comments on each paragraph of the Memorandum with additional pleas, if any, to the appellate authority with a copy to the appellants.

(6) The appellate authority shall record its decision after giving the parties to the appeal a reasonable opportunity of being heard. A copy of the decision shall be given to the parties to the appeal and a copy thereof shall be sent to the controlling authority returning his records of the case.

(7) The controlling authority shall, on receipt of the decision of the appellate authority, make necessary entry in the records of the case maintained in Form "Q" under sub-rule (1) of Rule 16.

(8) On receipt of the decision of the appellate authority, the controlling authority shall, if required under that decision modify his direction for payment gratuity and issue a notice to the employer concerned in Form "S", specifying the modified amount payable and directing payment thereof to the applicant, under intimation to the controlling authority within fifteen days of the receipt of the notice by the employer. A copy of the notice shall be endorsed to the applicant employee, nominee or legal heir, as the case may be and to the appellate authority.

Application for recovery of gratuity.- Where an employer fails to pay the gratuity due under the Act in accordance with the notice by the controlling authority under Rule 17 or Rule 18, as the case may be, the employee concerned, his nominee or legal heir, as the case may be, to whom the gratuity is payable may apply to the controlling authority in duplicate in Form "T" for recovery thereof under Section 8 of the Act.
Display of abstract of the Act and rules.- The employer shall display an abstract of the Act and the rules made thereunder in English and in the language under stood by the majority of the employees at a conspicuous place at or near the main entrance of the establishment.

Form "A"

[See sub-rule (1) of Rule 3]

Notice of Opening

The Controlling Authority,

.........................

Name and address of the establishment.
Name and designation of the employer.
Number of persons employed.
Maximum number of persons employed on any day during the preceding twelve months with date.
Number of employees covered by the Act.
Nature of Industry.
Whether seasonal?
Date of Opening.
Details of Head Office/Branches;

(a) Name and Address of the Head Office. Number of Employee

(b) Names & addresses of other Branches in India:-

I verify that the information furnished above is true to the best of my knowledge and belief.

Place.

Date.

Signature of the Employer with name and designation.

Form "B"

[See sub-rule (2) of Rule 3]

Notice of Change

The Controlling Authority,

.............................

Name and address of the establishment.

Take notice that following changes have taken place with effect from........................in the particulars furnished by me in notice dated...................in Form "A".

Name.

Address.

Name of the Employer.

Nature of Business,

Place.

Date.

Signature of the Employer with name and designation.

Form "C"

[See sub-rule (3) of Rule 3]

Notice of Closure

The Controlling Authority,

.............................

Take notice that it is intended to close down the establishment with effect from..........The other details are furnished below: -

Name and address of the establishment.
Name and address of the Head Office, if any.
Name & designation f the employer.
Number of persons in employment.
Number of employees entitled to Gratuity.
Amount of Gratuity involved.

Place.

Date.

Signature of the Employer with name and designation.

Form "D"

[See sub-rule (1) of Rule 5]

Notice for excluding husband from family

From:-

Name of the female employee.
Name or description of establishment where employed.
Post held with Ticket or Serial No., if any.
Department/Branch/section where employed.
Permanent address.

Take notice that I, Shrimati...................desire to exclude my husband Shri.............................. from my family for the purposes of the Payment of Gratuity Act, 1972.

Place.

Date.

Signature/Thumb impression of the Employer.

Declaration by witnesses

The above notice was signed/thumb impressed before me.

Name in full and full address of witnesses.	Signature of witnesses.
1.	1.
2.	2.

Place.

Date

The Controlling Authority (through the employer)

(Name and address of the employer here)

For use by the Employer

Received and recorded in this establishment.

Signature of the employer or an officer authorised in this behalf. Reference No. by the employer.

Date

(Employee).
The Controlling Authority

Note:- Strike out the words not applicable).

Form "E"

[See sub-rule (2) of Rule 5]

Notice of withdrawal of notice for excluding husband from family

From:-

Name of the female employee.
Name or description of establishment where employed.
Post held with Ticket or Serial No., if any.
Department/branch/Section where employed.
Permanent address.

Take notice that I, Shrimati...................desire to exclude my husband Shri.............................from my family for the purposes of the Payment of Gratuity Act, 1972.

Place.

Date.

Signature/Thumb Impression of the Employer

Declaration by witnesses

The above notice was signed/thumb impressed before me.

Name in full and full address of witnesses.	Signature of witnesses.
1.	1.
2.	2.

Place.

Date.

The Controlling Authority (through the employer)

(Name and address of the employer here).

For use by the Employer

Received and recorded in this establishment.

Reference No.

Signature of the Employer or an Officer authorised in this behalf by the Employer.

Date

(Employee).
The Controlling Authority

(Note:- Strike out the words not applicable).

Form "F"

[See sub-rule (1) of Rule 6]

Nomination

(Give here name or description of the establishment with full address)

I, Shri/Shrimati/Kumari......................(Name in full here) 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 the 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).

I hereby certify that the person(s) mentioned is/are member(s) of my family within the meaning of clause (h) of Section 2 of the Payment of Gratuity Act, 1972.
I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the said Act.
(a) My father/mother/parents is/are not dependent on me.

(b) My husband's father/mother/parents is/are not dependent on my husband.

I have excluded my husband from my family by a notice dated.................to the controlling authority in terms of the proviso to clause (h) of Section 2 of the said Act.
Nomination made herein invalidates my previous nomination.

Nominees

Name in full with full address of nominee(s)	Relationship with the employee	Age of nominee	Proportion by which the gratuity will be shared
1	2	3	4
1
2
3
4
so on.

Statement

Name of employee in full
Sex
Religion
Whether unmarried/married/widow/widower
Department/Branch/Section where employed
Post held with Ticket or Serial No., if any
Date of appointment
Permanent address-

Village......................	Thana....................	Sub-division.......................
Post Office.................	District......................	State................................

Place.

Date.

Signature/Thumb impression of the Employee.

Declaration by witnesses

Nomination signed/thumb impressed before me

Name in full and full address of witnesses.	Signature of witnesses.
1.	1.
2.	2.

Place.

Date.

Certificate by the Employee

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

Employer's Reference No., if any

Signature of the Employee/Officer authorised Designation

Date..............

Name and address of the Establishment or rubber stamp thereof.

Acknowledgement by the Employee

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

Date........

Signature of the Employee

Note:- Strike out the words/paragraph not applicable.

Form 'G'

[See sub-rule (3) of Rule 6]

Fresh Nomination

.......................

...........................

.........................

(Give here name or description of the establishment with full address)

I, Shri/Shrimati.................... whose particulars are given in the statement below, have acquired a family within the meaning of clause(h) of Section 2 of the Payment of Gratuity Act, 1972............ with effect from the............(date here).................. in the manner indicated below and therefore nominate afresh the portions 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 direct that the said amount of gratuity shall be paid in proportion indicated against the names of the nominees.

I hereby certify the persons nominated is/are member(s) of my family within the meaning of clause (h) of Section 2 of the said Act.
(a) My father/mother/parents is/are not dependent on me.

(b) My husband's father/mother is/are not dependent on my husband.

I have excluded my husband from my family by a notice dated the.....................to the Controlling Authority in terms of the proviso to clause (h) of Section 2 of the said Act.

Nominee(S)

Name in full with full address of nominee(S)	Relationship with the employee	Age of nominee	Proportion by which the gratuity will be shared
1	2	3	4
1
2
3
4
so on.

Manner of acquiring a "family"

(Here give details as to how a family was acquired, i.e. whether by marriage or parents being rendered dependent or through other process like adoption.

Statement

Name of the employee in full
Sex
Religion
Whether unmarried/married/widow/widower
Department/Branch/Section where employed
Post held with Ticket or Serial No., if any
Date of appointment
Permanent address-

Village......................	Thana....................	Sub-division.......................
Post Office.................	District......................	State................................

Place.

Date.

Signature/Thumb impression of the Employee.

Declaration by witnesses

Fresh nomination signed/thumb impressed before me.

Name in full and full address of witnesses.	Signature of witnesses.
1.	1.
2.	2.

Place.

Date.

Certificate by the Employer

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

Employer's Reference No. .......... if any

Signature of the Employee/Officer authorised Designation

Date..........

Name and address of the Establishment or rubber stamp thereof.

Acknowledgement by the Employee

Received the duplicate copy of nomination in Form.............filed by me on............duly certified by the employer.

Date...........

Signature of the Employer

Note:- Strike out the words/paragraph not applicable.

Form 'H'

[See sub-rule (4) of Rule 6]

Modification of nomination

........................

(Give here name or description of the establishment with full address)

I, Shri/Shrimati/Kumari.................(Name in full here) whose particulars are given in the statement below, hereby give notice that the nomination filed by me on............(Date) and recorded under your reference No.......... dated ...............shall stand modified in the following manner:-

Statement

Name of employee in full
Sex
Religion
Whether unmarried/married/widow/widower
Department/Branch/Section where employed
Post held with Ticket or Serial No., if any
Date of appointment
Permanent address

Place.

Date.

Signature /Thumb impression of the Employee.

Declaration by witnesses

Modification of nomination signed/thumb impressed before me.

Name in full and full address of witnesses.	Signature of witnesses.
1.	1.
2.	2.

Place.

Date.

Certificate by the Employer

Certified that the above modification have been recorded. Employer's Reference No., if any

Signature of the Employee/ Officer authorised Designation

Date....................

Name and address of the Establishment or rubber stamp thereof.

Acknowledgement by the Employee

Received the duplicate of the notice for modification in Form "H" filed by me on................duly certified by the employer.

Signature of the Employee

Date...............

Note:- Strike out the words/paragraph not applicable.

Form "I"

[See sub-rule (1) of Rule 7]

Application for gratuity by an employee

To,

............................

.............................

(Give here name or description of the establishment with full address.)

Sir/Gentlemen.

I beg to apply for payment of gratuity to which 1 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: -

Statement

Name in full
Address in full
Department/Branch/Section/ where last employed
Post held with Ticket No. or Serial No., if any
Date of appointment
Date and cause of termination of service
Total period of service
Amount of wages last drawn
Amount of gratuity claimed
I was rendered totally disabled as a result of (here give the details of the nature of disease or accident).

The evidences/witnesses in support of my total disablement are as follow:-

(Here give details)

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 due to me by Postal Money Order at the address mentioned above after deducting postal money order commission therefrom.

Yours faithfully

Signature/Thumb impression of the applicant employee

Place.........

Date..........

Note:- 1. Strike out the words not applicable

Strike out paragraph or paragraphs not applicable.

Form "J"

[See sub-rule (2) of Rule 7]

To,

......................

(Give here the name or description of the establishment with full address.)

Sir/Gentlemen,

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 as a nominee of late (Name of the employee)...........who was an employee of your establishment and died on............The gratuity is payable on account of the aforesaid employee while in service/superannuation of the aforesaid employee on................. retirement or resignation of the aforesaid employee on............after completion of................ year of service/total disablement of the aforesaid employee due to accident or disease while in service with effect from the........Necessary particulars relating to my claim are given in the statement below:-

Statement

Name of applicant nominee.
Address in full of the applicant nominee
Marital status of the applicant nominee (unmarried/married/ widow/widower).
Name in full of the employee
Marital status of employee
Relationship of the nominee with the employee
Total period of service of the employee
Date of appointment of the employee
Date and cause of termination of service of the employee
Department/Branch/Section where the employee last worked
Post last held by the employee with Ticket or Serial No., if any
Total wages last drawn by the employee
Date of death and evidence/witness as proof of death of the employee
Reference No. of recorded nomination, if available
Total gratuity payable to the employee
Share of gratuity claimed.
I declare that the particulars mentioned in the above statement are true and correct to the best of my knowledge and belief.
Payment may please be made in cash/crossed or open bank cheque.
As the amount payable is less than Rupees one thousand, I shall request you to arrange for payment of the sum due to me by Postal Money Order at the address mentioned above after deducting postal money order commission therefrom.

Yours faithfully

Signature/Thumb impression of the applicant employee

Place......

Date........

Note.1. Strike out the words not applicable

Strike out paragraph or paragraphs not applicable.

Form "K"

[See sub-rule (3) of Rule 7]

Application for gratuity by a legal heir

To,

..............................

...............................

(Give here the name or description of the establishment with full address)

Sir/Gentlemen,

I beg to apply for payment of gratuity to which 1 am entitled under sub-section (1) of Section 4 of the Payment of Gratuity Act, 1972 as a legal heir of late (Name of the employee)..............who was an employee of your.............establishment and died on the.......... without making any nomination. The gratuity is payable on account of the death of the aforesaid employee while in service/superannuation of the aforesaid employee on the........after completion of......... year of service/total disablement of the aforesaid employee due to accident or disease while in service with effect from the necessary particulars relating to my claim are given in the Statement below.

Statement

Name of the applicant legal heir
Address in full of applicant legal heir
Marital status of the applicant legal heir (Unmarried/married/widow/widower).
Name in full of the employee
Relationship of the applicant with the employee
Relation of both of the applicant and the employee
Date of appointment and total period of service of the employee
Department/Branch/Section where the employee worked last
Post last held by the employee with Ticket or Serial No., if any
Total wages last drawn by the employee
Date and cause of termination of service of the employee (death or otherwise)
Date of death of the employee and evidence/witness in support thereof
Total gratuity payable to the employee
Percentage of the gratuity claimed
Basis of the claim and evidence/witness in support thereof.
I declare that the particulars mention in the above statement are true and correct to the best of my knowledge and belief.
Payment may please be made in cash/open or crossed bank cheque.
As the amount payable is less than Rupees one thousand, 1 shall request you to arrange for payment of the sum to due me by Postal Money Order at the address mentioned above, after deduction postal money order commission therefrom.

Yours faithfully

Signature/Thumb impression of the applicant legal heir

Place..........

Date...........

Note:- Strike out the words not applicable

Form "L"

[See clause (i) of sub-rule (1) of Rule 8]

Notice for payment of gratuity

To,

..............................

...............................

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

You are hereby informed as required under clause (i) of sub-rule (1) of Rule 8 of the Rajasthan Payment of gratuity Rules, 1973 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 to.:.............and employee of this.........establishment.

Please call at..........on..........(Here specify place)................ (Date)........at.....for collecting your payment in cash/open or crossed cheque.

(Time)

Amount payable shall be sent to you by Postal Money Order at the address given in your application alter deducting the postal money order commission as desired by you, by................

Brief Statement of calculation

Total period of service of the employee concerned:-

.............years........months.

Wages last drawn.
Proportion of the admissible gratuity payable in terms of nomination/ as a legal heir.
Amount payable.

Place:

Signature of the employer/Authorised Officer.

Name or description of establishment or rubber stamp thereof.

Copy to the Controlling Authority.

Note:- Strike out the words not applicable.

Form "M"

[See clause (ii) of sub-rule (1) of Rule 8]

Notice rejecting claim for payment of gratuity

To.

............................

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

You are hereby informed as required under clause (ii) of sub-rule (1) or Rule 8 of the Rajasthan Payment of Gratuity Rules, 1973 that your claim for payment of gratuity as indicated on your application in Form.....................under the said rules is not admissible for the reasons stated below.

Reasons (Here specify the reasons) Signature of the employer/Authorised Officer.

Place:

Date:

Name and description of establishment or rubber stamp thereof.

Copy to the Controlling Authority.

Note:- Strike out the words not applicable.

Form "N"

[See sub-rule (1) of Rule 10]

Application for direction

Before the Controlling Authority under the Payment of Gratuity Act, 1972, Application No........

Dated....................

Between

(Name in full of the applicant with full address

And

Name in full of the employer concerned with full address)

The applicant is an employee of the above-mentioned employer/s nominee of late..............in employee of the above-mentioned employer/s legal heir of late.......................and employee if the above-mentioned employed, and is entitled to payment of gratuity under Section 4 of the Payment of Gratuity Act, 1972, on account of his own/aforesaid employee's superannuation on ............./his own retirement/aforesaid employees resignation...............(date)......... on................ after completion of......... years of continuous ..............(date) ..............service/his own/aforesaid employee's total disablement with effect from due to accident/decease/death of the aforesaid (date)............employee on................

The applicant submitted an application under rule............ of the Payment of Gratuity Act, 1972 on the...but the above mentioned employer refused to entertain it/issued a notice dated the..........under clause of sub-rule of rule...................offering an amount of gratuity which is less than my due/issued a notice dated the under clause ............... of sub-rule....of rule......rejecting my eligibility to payment of gratuity. The duplicate copy of the said notice is enclosed.
The application submits that there is a dispute on the matter (specify the dispute).
The applicant furnished the necessary particulars in the annexure hereto and prays that the Controlling Authority may be pleased to determine the amount of gratuity payable to the petitioner and direct the above mentioned employer to pay the same to the petitioner.
The applicant declares that the particulars furnished in the annexure hereto are true and correct to the best of his knowledge and belief.

Signature/Thumb impression of the applicant.

Date :

Annexure

Name in full of applicant with full address.
Basis of Claim.

(Death/Superannuation/Retirement/Resignation/Disablement of employee).

Name and address in full of the employee.
Marital status of the employee (Unmarried/ married/ widow/ widower)
Name and address in full of the employer.
Department/Branch/Section where the employee was last employed (if known).
Post held by the employee with Ticket or Serial No., if any (if known).
Date of appointment of the employee (if known).
Date and cause of termination of service of the employee (superannuation/retirement/resignation/disablement/death).
Total period of service by the employee.
Wages last drawn by the employee.
If the employee is dead, date and cause thereof.
Evidence/witness in support of death of the employee.
If a nominee, No. and date of recording of nomination with the employer.
Evidence/witness in support of being a legal heir, if a legal heir.
Total gratuity payable to the employee (if known).
Percentage of gratuity payable to the applicant as a nominee/legal heir
Amount of gratuity claimed by the applicant.

Signature/Thumb impression of the Applicant.

Place.................

Date............

Note:- Strike out the words not applicable.

Form "O"

[See sub-rule (1) of Rule 11]

Notice for appearance before the Controlling Authority

From:

The Controlling Authority under the Payment of Gratuity Act, 1972.

To,

............................

.............................

(Name and address of the employer/applicant)

Whereas Shri.............................an employee under you/a nominee(s) legal heir(s) of Shri...................an employee under the above mentioned employer, has/have filed an application under sub-rule (1) of Rule 10 of the Rajasthan Payment of Gratuity Rules, 1973 alleging that-

(A copy of the said application is enclosed)

Now, therefore, you are hereby called upon to appear before me at (Place).................either personally or through a person duly authorised in this behalf for the purpose of answering all material questions relating to the application on the............. day of 19............... at........O'clock in the forenoon/afternoon in support of/to answer the allegation; and as the day fixed for your appearance is appointed for final disposal of the application, you must be prepared to produce on that day all the witnesses upon whose evidence, and the documents upon which you intend to rely in support of your allegation/defence.

Take notice that in a default of your appearance on the day before mentioned i.e. application will be submission/heard and determined in your absence.

Given under my hand and seal, this..............day of.......19.......

Controlling Authority.

Note:- Strike out the words and paragraphs not applicable.

Form "P"

(See Rule 14)

Summons

Before the Controlling Authority under the Payment of Gratuity Act 1972.

To,

.....................

(Name and address)

Whereas your attendance is required to give evidence/you are required to produce the documents mentioned in the list below, on behalf of........ in the case arising out of the claim for gratuity by.......... from............and referred to this Authority by an application under Section 7 of the Payment of Gratuity Act, 1972, you are hereby summoned to appear personally before this Authority on the day of 19............ O’clock in the forenoon/afternoon and to bring with you (or to send to this Authority) the said documents.

List of Documents

so on

Controlling Authority.

Dated, this............day of..........19....

Notes:-(1) The portion not applicable to be deleted.

(2) The summons shall be issue din duplicate. The duplicate is to be signed and returned by the person served before the date fixed.

(3) In case the summons is issued only for producing a document and not to give evidence, it will be sufficient compliance to the summons, if the documents are Caused to be produced before the Controlling Authority on the day and hour fixed for the purpose.

Form "Q"

[See sub-rule (1) of Rule 16]

Particulars of application under Section

Serial No.
Date of the application.
Name and address of the applicant.
Name and address of the employer.
Amount of gratuity claimed.
Dates of hearing.
Findings with date.
Amount awarded.
Cost, if any, awarded.
Date of notice issued for payment of gratuity.
Date of appeal, if any.
Decision of the Appellate Authority.
Date of issue of Final Notice for payment of Gratuity.
Date of Payment of Gratuity by Employer with mode of payment.
Date of Receipt of application for recovery of gratuity.
Date of issue of Recovery Certificate.
Date of Recovery.
Other remarks.
Date.

Signature of the Controlling Authority.

Form "R"

(See Rule 17)

To,

......................

(Name and address of employer)

Whereas Shri/Smt./Kumari..............................on.............. (address).........................an employee under you/ a nominee (s) legal heir (s) of late.................an employee under you, filed an application under Section 7 of the Payment of Gratuity Act, 1972 before me;

And whereas the application was heard in your presence on and after the hearing I have come to the finding that the said Shri/ Smt./Kumari................ is entitled to a payment of Rs as gratuity under the Payment of Gratuity Act, 1972;

Now, therefore, 1 hereby direct 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. 19.........

Controlling Authority

Copy to:-

(Applicant under rule)

He is advised to contact the employer for collection payment.

Note - the portion not applicable to be deleted.

Form "S"

[See sub-rule (5) of Rule 18]

Notice for payment of Gratuity as determined by Appellate Authority

To,

.............................

..............................

(Name and address of employer)

Whereas a notice was given to you on...................From ’R’ requiring you to make a payment of Rs........................to Shri/Smt./Kumari................. as gratuity under the Payment of gratuity Act, 1972:

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 Payment of Gratuity Act, 1972;

Now, therefore, hereby direct you to pay the said sum of Rs........... to Shri/Smt./Kumari..................... within 30 days of the receipt of this notice with an intimation thereof to me.

Given under my hand and seal this day of 19..................

Controlling Authority

Copy to:-

The Applicant........

He is advised to contact the employer for collecting payment.

The appellate Authority.

Note.- The portion not applicable to be deleted.

Acknowledgement by the employee.

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

Signature of the Employee

Dated...........

Note.- Strike out the words/paragraph not applicable;

Form "T"

(See Rule 19)

Application for recovery of gratuity

Before the Controlling Authority under the Payment of Gratuity Act, 1972.

Dated............

Application No. ........

Between

(Name in full of the applicant with address)

and

(Name in full of the employer with full address)

The applicant is an employee of the above-mentioned employer a nominee of late........an employee of the above-mentioned employer a legal heir of late.............an employee of the above-mentioned employer, and you were pleased to direct the said employer in your notice dated the .............under rule...........of the Payment of Gratuity (State) Rules, 1972 for payment of a sum of Rs...............

the applicant submits that the said employer failed to pay the said amount of gratuity to me as directed by you although 1 approached him for payment.
The applicant therefore prays that a certificate may be issued under Section..........of the said Act for recovery of the said sum of.............due to me as gratuity in terms of your direction.

Signature/Thumb impression of the Applicant.

Place:

Date: