FORM NO. 2 [See rule 53(1)] Nomination for Death-cum-Retirement Gratuity when the Govt. servant has no family and wishes to nominate one person or more than on person. I,..........having no family, hereby nominate in person/persons mentioned below and confer on him/them the right to receive to the extent specified below any gratuity that may be sanctioned by the H.P. Govt. in the event of my death while in service and the right to receive on my death, to the extent specified below any gratuity which having become admissible to me on retirement may remain unpaid at my death. ORIGINAL NOMINEE (S) ALTERNATE NOMINEE (S) Name and Relation Age Amount of Name and address, Amount of address of share* relationship and age of the share of nominees/ person /or persons, if any to gratuity nominee whom the right conferred on the nominee predeceasing the Govt. servant but before receiving payment of gratuity payable to each** 1 2 3 4 5 6 * This column should be filled in so as to cover the whole amount of gratuity. ** The amount/share of the gratuity shown in this column should cover the whole amount / share payable to the original nominee (s). This nomination supersedes the nomination made by me earlier on... which stand cancelled. Note. (1) The Govt. servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he has signed. (2) Strike out which is not applicable. Dated this ....... day of ........at............ Witnesses to sign here: -1............... 2............... 3............... Signature of Applicant. (TO BE FILLED IN BY THE HEAD OF OFFICE/ACCOUNTS OFFICER) Nomination by ............... Designation ................. Office.................... Signature of Head of Office/Accounts Officer Dated .......... Designation....... DETAILS OF FAMILY [See rule 54 (12)] Name of Govt. servant ............................ Designation .............. Date of Birth ............ Date of appointment ......... Details of the members of my family as on ............... Sl. No. Name of the member of the family* Date of birth Relationship with officer/ official Initials of Head of Office Remarks 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. I hereby undertake to keep the above particulars upto date by notifying to the Officer/ Head of Office/Account any addition or alternation. Place..... Dated the ........ Signature of the Govt. servant. *Family for the purpose means:- (a) Wife, in the case of a male Govt. servant. (b) Husband in the case of a female Govt. servant. (c) Sons below twenty-one year of age and un-married daughters below twenty four years of age, including such son or daughter adopted legally before retirement. Note: - Wife and husband shall include respectively judicially separated wife husband. (In accordance with the provision to sub-rule (54) inserted G.I.M.P Notification No. F.I (S)-IV (B) /74, dated 30-9-74, if a son or daughter of a Govt. servant is suffering from any disorder or disability of mind or is physically crippled or disabled so as to render him or her unable t earn living even after attaining the age of 21 years in the case of son and 24 years in case of the daughter. (For details see the provision ibid to sub-rule (6) of rule 54).
