From ********************, ***********************, ***********************, Ennore Thermal Power Station, Ennore, Chennai 57. To The Superintending Engineer, Purchase and Administration, Ennore Thermal Power Station, Ennore, Chennai 57. Sir, Through Proper Channel Sub- Estt. Class-III Service *************** Revised Nomination for G.P.F., D.C.R.G., FBFSS, Spl.PF Cum Gratuity and FBFS Submission of Regarding. ****** I submit herewith the nomination in triplicate for the G.P.F., D.C.R.G., F.B.F.S.S., Spl.P.F Cum Gratuity and F.B.F.S. for further action. Thanking You, Yours faithfully, Encl.- 3 Nos. Nomination in Triplicate. DATE- (**********************) PLACE-
APPLICATION FORM FOR ADMISSION INTO TAMIL NADU ELECTRICITY BOARD GENERAL PROVIDENT FUND SCHEME (REFERRED TO IN REGULATION 5 (ii) (To be submitted in Duplicate simultaneously with the nomination in the prescribed form) Account Number to be allotted by the Accounts Officer. Name of Applicant (in block letters) 3. Designation 4. Office to which attached 5. Date of Birth 6. Emoluments per mensum (Pay.Spl.pay, etc., and dearness allowance to be shown separately) 7. Rate of monthly subscription 8. Whether compulsory or optional Subscriber 9. Date of Regular appointment 10. Date of completion of one year of continuous service. 1 Date of regular absorption in Electricity Board s Service. (In the case of acquired Electrical undertakings only) 1 Date from which Electricity Board s contribution is admissible. 13. If subscriber to any other fund name of such fund and the account number there to 14. Whether the applicant has a family or not. I hereby declare that I have read and understood the Tamil Nadu Electricity Board General Provident Fund Regulations and I agree to become a subscriber and to be bound by the Regulations of the Fund for the time being in force and as may from time to time be prescribed. SIGNATURE OF THE APPLICANT....
Certified that... CERTIFICATE TO BE FURNISHED BY THE HEAD OF THE OFFICE. 1) is eligible to join the Tamil Nadu Electricity Board s General Provident Fund Account with reference to Electricity Board s proceedings Ms.No.1807 dated 29 th July 1965. 2) That he/she is likely to be in service without a break. 3) As the applicant is illiterate the regulation of the Tamil Nadu Electricity Board General Provident Fund have been explained to him/her hereby no and I certify that he/she understands them. (To be furnished only in the case of an illiterate applicant). STATION DATE HEAD OF OFFICE. (B.P.Ms.No.66 Dated 2 nd April 1973) FOR USE IN THE OFFICE OF THE ACCOUNTS OFFICER No. fds) Returned with the Account Number duly allotted. This number should be quoted in all correspondences connected therewith. 2) The nomination in the prescribed form has not been received in returned herewith remarks. The same may be returned early duly rectified or with the omissions supplied. 3) Arrears of subscription for the period from together with interest there on may be recovered in addition to the regular monthly subscriptions (after obtaining orders of the Electricity Board, if necessary). 4) The total amount of arrears of subscriptions and the number of instalments in which it is proposed to recover the arrears may be intimated. 5) Necessary gross pay statement for the period for which arrears of subscription have been recovered may be sent to this office for adjusting the Electricity Board s contribution due. ACCOUNTS OFFICER/FUNDS...3..
..3.. FORM OF NOMINATION FOR TAMIL NADU ELECTRICITY BOARD GENERAL PROVIDENT FUND WHEN THE MEMBER HAS A FAMILY AND WISHED TO NOMINATE ONE MEMBER THE THERE OF I hereby nominate the person mentioned below, who is a member of my family as defined in Regulation 9 of the Tamil Nadu Electricity Board General Provident Fund Regulations, to receive the amount that may stand to my credit in the Fund, in the even of my death before that amount has become payable or having become payable has not been paid. Name and Address of Nominee Relation - ship with member Contigencies on the happening of the which the nomination shall become invalid. Name, Address & relationship of the person, if any to whom the right of the nominee shall pass in the event of his predeceasing the member. The Nomination shall become invalid in the event of the Nominee s predeceasing the member. Date this day of at TWO WITNESSES TO SIGNATURE. SIGNATURE OF MEMBER...4..
..4.. FORM OF NOMINATION FOR TAMIL NADU ELECTRICITY BOARD GENERAL PROVIDENT FUND WHEN THE MEMBER HAS NO FAMILY AND WISHES TO DATE ONE PERSON I having no family as defind in Regulation 9 of the Tamil Nadu Electricity Board General Provident Fund Regulations, hereby nominate the person mentioned below to receive the amount that may stand to my credit in the Fund, in the event of my death before that amount has become payable or having become payable has not been paid. Name and Address of Nominee Relationship with member. Contigencies on the happening of the which the nomination shall become invalid. This Nomination shall become null and volid when I acaquire a family Name, Address & relationship of the person, if any to whom the right of the nominee shall pass in the event of his processing the member. Date this day of at TWO WITNESSES TO SIGNATURE. SIGNATURE OF MEMBER...5..
..5.. NOMINATION FOR DEATH-CUM-RETIREMENT GRATUTY WHENEVER THE SUBSCRIBER HAS A FAMILY AND WISHED TO NOMINATE ONE NUMBER THERE ON. I hereby nominate the person mensioned below who is a member of my family and confer on his/her the right to receive any Gratuity that may be sanctioned by Tamil Nadu Electricity Board in the event of my death while in Service and the right to receive on my death and Gratuity which having become admissible to me on retirement may remain unpaid at my death. Name and Address of Nominee Relationship with officer. Contigencies on the happening which the nomination shall be come invalid. Nomination shall become in valid in the event of the nominee s predeceasing the Member Name, Address & relationship of the person, if any to whom the right conferred on the nominee shall pass in the event the nominee dying after death of subscriber but before receiving payment of the Gratuity Amount of share or Gratutiy payable to each The nomination superseds the nomination made by me earlier in respect of this benefit. WITNESS Dated this day of of SIGNATURE OF SUBSCRIBER.
..6.. NOMINATION OF TAMIL NADU ELECTRICITY BOARD EMPLOYEE s FAMILY BENEFIT SCHEME (RULE 9) FORM OF NOMINATION WHEN THE SUBSCRIBER HAS A FAMILY AND WISHES TO NOMINATE ONE MEMBER THERE OF I hereby nominate the person mentioned below, who is a Member of my family as defined in Rule.9 of the Tamil Nadu Electricity Board Employees Family Benefit Fund Rules to receive the lumpsum amount under family benefit fund scheme in the event of my death during my service. Name and Address of Nominee Relation ship with employee Contigencies on the happening which the nomination shall be come invalid. Name, Address & relationship of the person, if any to whom the right conferred on the nominee shall pass in the event the nominee dying after death of subscriber but before receiving payment of the Gratuity Amount of share or Gratutiy payable to each Dated this day of TWO WITNESS TO SIGNATURE. SIGNATURE OF SUBSCRIBER...7..
..7.. NOMINATION OF TAMIL NADU ELECTRICITY BOARD EMPLOYEES SPECIAL PROVIDENT FUND-CUM-GRATUTIY SCHEME When the Board Employee has a Family and wished to Nominate One Member or more than Member there of I hereby nominate the person are persons mentioned below, who is member(s) of family and confer on him/the right to receive to the extent specified below, the Tamil Nadu Electricity Board Employees Special Provident Fund-Cum-Gratutity Scheme which having become admissible to me on retirement mayremain unpaid at my death. ORIGINAL NOMINEE(S) Name & Address of Relation Nominee/ Naminess hip with employee ALTERNATE NOMINEE (S) Name, Address & Amount of share of relationship of the Tamil Nadu person, if any to Electricity Board whom the right conferred on the nominee shall pass in the event the nominee dying after death of subscriber but before receiving payment of the Gratuity Employee special provident Fund-Cum- Gratuity scheme payable to each. Nomination shall become in valid in the event of the nominee s predeceasing the Member This nomination superedes the nomination made by me earlier in respect of this benefit...8..
..8.. NOTE 1) The Board Employees 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. This column should be filled in so as to cover the whole amount of the Gratuity. The amount share of the Gratuity shown in this column should cover the whole amount share payable to the original nominee(s). Dated this day of WITNESS TO SIGNATURE. SIGNATURE OF THE BOARD EMPLOYEE. Nomination by (TO BE FILLED IN BY THE HEAD OF OFFICE AUDIT OFFICE) Designation Date..9..
..9.. NOMINATION FOR TAMIL NADU ELECTRICITY BOARD EMPLOYEES FAMILY BENEFIT SUBSIDIARY SCHEME. Name and Address of Nominee Relationship with Employee Dated the day of SIGNATURE OF THE EMPLOYEE. WITNESS TO SIGNATURE