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Nomination Form

The document outlines various forms related to government servants in Tamil Nadu for family details, nominations for pensions, gratuities, and other benefits. It includes sections for providing personal information, details of family members, and designating nominees for different financial entitlements in the event of the government servant's death. Each form requires signatures and witness attestations to validate the nominations and ensure proper processing.

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gurunathravichandran2010
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313 views9 pages

Nomination Form

The document outlines various forms related to government servants in Tamil Nadu for family details, nominations for pensions, gratuities, and other benefits. It includes sections for providing personal information, details of family members, and designating nominees for different financial entitlements in the event of the government servant's death. Each form requires signatures and witness attestations to validate the nominations and ensure proper processing.

Uploaded by

gurunathravichandran2010
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

FORM– 3

(See Rule 49 (12)

Details of Family

Name of the Government Servant :

Designation :

Date of Birth :

Date of appointment :

Details of the members of my family as on

----------------------------------------------------------------------------------------------------------

Sl. Name of the members Date of Relationship Initials of Remarks


No. of the family Birth with the Officer. the Head of
the office
(1) (2) (3) (4) (5) (6)

----------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------

I hereby undertake to keep the above particulars up to date by notifying to the


Audit
Officer/Head of office any addition or alternation.

Place :
Date : Signature of the Govt. Servant.
FORM – 4
(See Rule 50(6)
NOMINATION FOR NON – CONTRIBUTORY FAMILY PENSION

I, hereby nominate the persons mentioned below, who are


members of my family to receive in the order shown below, the non – contributory
family pension which may be granted by the Government in the event of my death
after completion of ten years qualifying service.
---------------------------------------------------------------------------------------------------------
Name and address of Relationship Age Whether married
the Nominee With the Govt. or unmarried.
servant.
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------
The nomination supersedes the nomination made by me earlier on which
stands cancelled.

Dated this day of 201 at Chennai

Witness to Signature :

1.

2. Signature of Govt. Servant.

Attested
FORM – I
Sec Rule 53 (1)
Section X
NOMINATION FOR TAMIL NADU GOVERNMENT EMPLOYEES SPECIAL FUND-CUM-GRATUITY SCHEME

When the Government Servant has a family and wishes to nominate one member or more than one member, thereof
I, hereby nominate the person / persons mentioned below who is / are members of my family
and confer on him/them the right to receive, the extent specified below, any Tamil Nadu Government employees Special
Provident Fund –Cum –Gratuity that may be sanctioned by the Government in the event of Death while in service and the right
to receive on my death, to the extent specified below, any Tamil Nadu Government employees Special Provident Fund - Cum –
Gratuity Scheme which having become admissible to me on retirement may remain unpaid at my death.
-------------------------------------------------------------------------------------------------------------------------------------------------------------
Original Nominee(s) Alternative Nominee(s)
-------------------------------------------------------------------------------------------------------------------------------------------------------------Name and
Address of Relationship Age Amount Name, address, relationship and Amount of share
Nominee /Nominees with Govt. or age of the persons, if any to whom of Tamil Nadu
Servant. Share of the right conferred on the nominee Govt. E.S.P. fund-
Gratuity. shall pass in the event of the nominee Cum-Gratuity
Predeceasing the Govt. servant or the scheme payable to
dying after the Govt. servant but before each.
receiving payment of gratuity.
-------------------------------------------------------------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------------------------
This nomination supersedes the nomination made by the earlier on which is stands cancelled.
Dated this day of at Chennai.

Witness to Signatures :

1.

2.

Signature of Govt. Servant.

(Attested)
FORM – I
ANNEXURE
FORM OF NOMINATION

I, hereby nominate the persons mentioned below whose Account Number is / are
members(s) / non members of my family as defined in rule 2 of the General Provident Fund Tamil Nadu rules to receive the
amount that may stands by my credit in the Fund as indicated below in the event of my death before that amount has become
payable or having become payable has not been paid.
-------------------------------------------------------------------------------------------------------------------------------------------------------------

Name and Address of Relationship Age Share Contingencies Name, address, relationship If the nominee
the Nominee(s) with the of the payable of the happening of the persons(s), if any whom is not the
family
Subscriber Nominee to each of the which the the right of nominee shall pass as provided in
nomination will in the event of his/her rule 2 indicate
become invalid Predeceasing the subscriber the reason.
(1) (2) (3) (4) (5) (6) (7)
-------------------------------------------------------------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------------------------

Dated this day of at Chennai.

Two witness to Signatures


Name and Address. Signature :
1.

2.
Signature of Govt. Servant.
(Attested) Name in Block Letter
Designation.
FORM – I
Sec Rule 53 (1)
NOMINATION FOR DEATH-CUM-GRATUITY

When the Government Servant has a family and wishes to nominate one member or more than one member, thereof
I, hereby nominate the person / persons mentioned below who is / are members of my family
and confer on him/them the rights to receive, to the extent specified below, any Gratuity that may be sanctioned by the
Government in the event of my death while in service and the right to receive on my death, the extent specified below, any
gratuity which having become admissible to me on retirement may remain unpaid at my death.
-------------------------------------------------------------------------------------------------------------------------------------------------------------Name and
Address of Relationship Age Amount Name, address, relationship and Amount of share
Nominee /Nominees with Govt. or age of the persons, if any to whom of Gratuity
Servant. Share of the right conferred on the nominee payable to each
Gratuity shall pass in the event of the nominee
payable Predeceasing the Govt. servant or the
to each dying after the Govt. servant but before
receiving payment of gratuity.
-------------------------------------------------------------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------------------------
This nomination supersedes the nomination made by me earlier on which is stands cancelled.

Dated this day of at Chennai.

Witness to Signatures :

1.

2.

Signature of Govt. Servant.


(Attested)
COMBINED NOMINATION FOR ARREAR OF PENSION AND COMMUTATION OF PENSION
( See Rule 48 of Tamil Nadu Pension Rules, 1978 and Rule 12 of Tamil Nadu Civil Pensions (Commutation) Rules, 1944)

I, ________________________ _____________________________(Name of the Pensioner in Capital Letters), hereby


nominate the person / persons mentioned below and confer on him / her/ them the right to receive in the event of my death, to the
extent specified below, amount on account of the (i) Arrears of Pension and (ii) Commuted value of pension.
Name, DoB and
address of Name, DoB and
If nominee is minor,
alternate address of person Contingency on
Name, DoB and Relationship
Share to nominee in case who may receive happening of
Relationship address of the person with employee/
be paid to the nominee the amount if which nomination
Name, Date of Birth and full with the who may receive the pensioner
each under column (1) alternate nominee shall become
address of the nominee(s) employee/ amount on behalf of
predeceases the in column (5) is a invalid
Pensioner minor
employee/ minor
pensioner
(1) (2) (3) (4) (5) (6) (7) (8)

These nomination supersede any nomination made by me earlier.


Place : Chennai -7
Date : - -2025 Signature of the Subscriber.
Signature of two witnesses with Name and Address:
1.

2.

-/Countersigned/-

Signature of Head of Office.


Office Address:
NOMINATION FOR GRATUITY
( See Rule 45 of Tamil Nadu Pension Rules, 1978)

I, ________________________ _____________________________(Name of the Pensioner in Capital Letters), hereby


nominate the person / persons mentioned below and confer on him / her/ them the right to receive in the event of my death, to the
extent specified below, amount on account of any gratuity which having become admissible to me on retirement may remain
unpaid at my death.
Name, DoB and
address of Name, DoB and
If nominee is minor,
alternate address of person Contingency on
Name, DoB and Relationship
Share to nominee in case who may receive happening of
Relationship address of the person with employee/
be paid to the nominee the amount if which nomination
Name, Date of Birth and full with the who may receive the pensioner
each under column (1) alternate nominee shall become
address of the nominee(s) employee/ amount on behalf of
predeceases the in column (5) is a invalid
Pensioner minor
employee/ minor
pensioner
(1) (2) (3) (4) (5) (6) (7) (8)

These nomination supersede any nomination made by me earlier.


Place : Chennai -7
Date : - -2025 Signature of the Subscriber.
Signature of two witnesses with Name and Address:
1.

2.
/Countersigned/-

Signature of Head of Office.


Office Address:
NOMINATION FOR LIFE TIME ARREARS OF PENSION
I, ________________________ _____________________________(Name of the Pensioner in Capital Letters), hereby
nominate the person / persons named below under Rule 48 of Tamil Nadu Pension Rules, 1978.

Name and address of


Relationship with Contingency on
other nominee in case the
Relationship employee/ happening of which
Date of age nominee under column Date of age
Name and full address of the with the pensioner nomination shall
(1) predeceases the
nominee(s) employee/ become invalid
pensioner.
Pensioner
(1) (2) (3) (4) (5) (6) (7)

Note : If nominee / alternate nominee is minor, furnish the name and address of person who may receive the arrears of pension.
Place : Chennai -7
Date : - -2025 Signature of the Subscriber.
Signature of two witnesses with Name and Address:
1.

2.
/Countersigned/-

Signature of Head of Office.


Office Address:

Common questions

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Nomination forms are integral to legal compliance in government employment by ensuring that the wishes of the government servant regarding the distribution of posthumous benefits are clearly documented and legally enforceable. These forms prevent disputes by establishing clear, predefined beneficiary designations, thereby aligning with legal frameworks governing employment benefits and pensions. They also provide mechanisms to update nominations, ensuring ongoing compliance with current laws and regulations .

Designating alternative nominees is crucial because it ensures that the distributions from pensions, gratuities, or provident funds can still be processed if the primary nominee predeceases the government servant. This precaution helps in preventing any legal or administrative disputes at the time of distribution, ensuring the benefits are allocated as per the government servant's intentions .

Mechanisms include the requirement for government servants to formally nominate individuals for various benefits using specific forms such as FORM-4 and others for specific funds or gratuities. These nominations must be up-to-date and supersede any prior nominations, and they require the signatures of the government servant and witnesses. Additionally, any changes must be notified to the relevant authorities, provided that the nominees predecease the servant or other injustices arise .

Witnesses play a vital role in the completion and validation of nomination forms by providing authentication to the nominations made by the government servant. Their signatures are required to confirm that the nomination has been executed voluntarily by the servant in their presence, which serves as a legal checkpoint to prevent undue influence or falsification of documents .

Nomination forms for various schemes and pensions significantly impact a government servant's retirement and post-death financial planning by providing a structured approach to ensuring family members are taken care of financially. Such forms dictate the distribution of pensions, gratuities, and provident fund benefits, thus playing a crucial role in estate planning. By pre-designating beneficiaries, these forms remove ambiguities and streamline the process, enabling precise execution of the servant’s financial plans post-retirement and ensuring family security .

The Tamil Nadu Pension Rules provide a structured framework for managing pension arrears and commutation through specified nomination forms. For example, they allow pensioners to designate individuals to receive pension arrears and commuted value of pensions posthumously. These rules ensure that the process is orderly and guarantees compliance with the pensioner's plans for post-retirement financial matters, while including contingencies for changes in nominee status .

Failing to update nomination forms can lead to a range of issues, including legal disputes among potential beneficiaries, delays in the payment of benefits, and financial hardship for family members who may otherwise be the intended beneficiaries. It may also result in payouts to unintended individuals if the servant's family circumstances have changed. Maintaining updated forms ensures compliance with current wishes and mitigates complications in posthumous benefit distributions .

The Tamil Nadu Government Employees Special Provident Fund-Cum-Gratuity Scheme allows government servants to nominate family members who will receive funds and gratuities payable due to the servant's demise. This scheme provides financial security to the nominee(s) by ensuring receipt of unpaid or due payments as per the nominations, thereby safeguarding the financial interests of the family .

FORM-3 serves as an official document for government servants to list details about their family members. This form is crucial for keeping the family details up-to-date for administrative purposes, such as benefits and other entitlements. Government servants are required to notify any changes in the family details to the Audit Officer or the Head of Office .

FORM–4 enables government employees to nominate family members who would receive the non-contributory family pension in case of the employee's death after completing ten years of qualifying service. This form allows priority ordering among nominees, thus ensuring a clear directive for pension distribution, which contributes to efficient pension planning and management for employees and their families .

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