FIRST SCHEDULE (RULE-5(3)) FORM OF NOMINATION When the subscriber has a family and wishes to nominate one member thereof. I hereby nominate the person mentioned below, who is a member of my family as defined in rule 2 of the General Provident Fund, (CS) Rules, 1960, to receive the amount that may stand to any credit in the fund, in the event of my death before that amount has become payable or having payable has not been paid. Name and address of the Nominee Relationship with the Subscriber Age Contingencies on the happening of which nomination shall become invalid Name, Address & Relationship of persons, if any to whom the right of the nominee shall pass in the event of predeceasing the subscriber 1 2 3 4 5 Dated this th day of....... at............... Signature of subscriber Two witness to signature 1.__________________ 2.__________________
