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www.sahayam.in
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FORM OF NOMINATION
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See Rule 9 (1) (iii) XXX-7(3)
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 I…… ………………………………………………………………………………. do hereby nominate the person(s) mentioned below to receive the amount that may stand to my edit in the fund in the event of my death before that amount has become payable or having become payable, has not paid.
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Name and full Permanent Address of Nominee(s)Relationship with the SubscriberAgeShare Payable to eachContingencies on the happening of which the Nomination shall become invalidName, address, relationship and age of the person to whom the right of the nominee shall pass in the event of his predeceasing the subscriberName and address of the person to whom share is to be paid on behalf of minor
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Signature & Address of the Witnesses:
Signature of the Applicant
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(Counter signed by Head of Office (Required only when Subscriber is a Non Gazetted Government Servant)
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