FORM 'F' Applicant ID: 2207787

See sub-rule (1) of

Gratuity Nomination Form
To,
TATAConsultancy Services Ltd,
9th Floor, Nirmal Building.
Nariman Point, Murnbai 400021.
, KYA NAGAR whose particulars are given in the statement below,hereby nominate the person(s) mentioned below to
receive the gratuity payable after my death as also the gratuity standing to my credit in the event of my death before that
amount has become payable, or having become payable has not been paid and diret that the said amount of gratuity
shall be paid in proportion indicated against the name(s) of the nominee(s).

2hereby certify thatof Gratuity

2 of the Payment the person(s) nominated is/area member(s) of my family within the meaning of clause (h) of Section
Act, 1972.
Yes
3.Ihereby declare that Ihave no family within the meaning of clause (h) of Section 2 ofthe said Act. NA
4. (a)My father is not dependent on me. No
(b) My mother is not dependent on me. No
(c) My spouse's father is not dependent on my spouse. NA
(d) My spouse's mother is not dependent on my spouse. NA

5. Nomination made herein invalidates my previous nomination.

Nominee(s)
Sr Name in full with full Relationship Date of Proportion by Name , relationship and address of
No. address of nominee(s) with the Birth which gratuity Guardian if nominee is minor
employee will be shared

1 Mr. Arun Kumar Nagar Father 15/12/1972 50

House Number 217, Ward
05, Pani Ki Tanki Ke Pas,
Near Anand Vihar,
Abhinandan Main Colony,
Mandsaur (M.P),
Abhinandan Main Colony,
Near Anand Vihar Gate,
Mandsaur- 458001, Madhya
Pradesh, India
2 Ms. Sangeeta Nagar Mother 13/0211978 50
House Number 217, Ward
05, Pani Ki Tanki Ke Pas,
Near Anand Vihar
Abhinandan Main Colony,
Mandsaur (M.P),
Abhinanden Main Colony,
Near Añând Vihr Gte,
Mandsaur- 458001, Madhya
Pradesh, India

20-0ct-2024
Page 1 of 2
 Statement
Full Name: RIYA NAGAR Applicant ID: 2207787
|Gender: F Date of Joining: 07-Nov-2024
Martial Status: Single Department: NA
Religion: NA
Permanent Address: House Number 217, Ward 05, Pani
Ki TankiKe Pas, Near Anand Vihar
,Abhinandan Main Colony,
Mandsaur (M.P) Abhinandan Main
Colony Near Anand Vihar Gate
Mandsaur Madhya Pradesh 458001 Signature of Employee:
Date:
Place: MANDSAVR

DECLARATION BY WITNESSES
Nomination signed before me
SR No. Name in full and full Address of Witnesses Signature of Witnesses
1
KAMLESH JOSHI- Son keshwa,Parasnath colony
2 |AMBALAL SHARMA 314/B,A 6hinandoan man. AMbala
Date : ol 1o 20Q4 Place : MANDSAvR

CERTIFICATE BY THE EMPLOYER

Certified that the particulars of the above nominations have been verified and recorded in this establishment

Office Seal Signature of the employertrustee

ACKNOWLEDGEMENT BY THE EMPLOYEE

Received the duplicate copy of nomination in Form 'F fled by me and duly certified by the employer.
Date :2oo204 Signature of the employee :

20-0ct-2024 Page 2 of 2
 FORM -2
Applicant ID: 2207787
Pension Number :MH/BANi48475/
NOMINATION AND DECLARATION FORM FOR UNEXEMPTED/EXEMPTED ESTABLISHMENTS
Declaration and Nomination Form under the Employees Provident Fund and Employees Pension Scheme (Rule 25 of
the Tata Consultancy Services Employees Provident Fund Rules &Paragraph &Paragraph 18 of the Employees
Pension Scheme, 1995)

1. Name(ln Block Letters):RIYA NAGAR

2. Father's Husband's Name: Arun Kumar
Nagar
3. Date of Birth: 27/10/2001
4. AMale/Female :Female
5. Marital Status: Single
6. PF AcCount Number :
MH/BANI48475/
7. Address:

Pemanent: House Number 217, Ward 05, Pani Ki TankiKe Pas, Nea Anand Viha, Abhinandan Main Coleny.
Mandsaur (M.P) Abhinandan Main Colony Near Anand Vihar Gate Mandsaur Madhya Pradesh 458001
Temporary : House Number 217, Ward 05, Pani Ki Tanki Ke Pas, Near Anand Vihar,Abhinandan Main Colony.
Mandsaur (M.P) Abhinandan Main Colony Near Anand Vihar Gate Mandsaur Madhya Pradesh 458001
8.(a)Date of joining EPF Scheme, 1952 :07/11/2024
(b)Date of joining E.P.Scheme, 1995 : 0ZI1/2024

PART -A (EPF)
Ihereby Nominate the person(sycancel the nomination made by me previously and nominate the person(s) mentioned
below to receive the amount standing to my credit in the Employees Provident Fund, in the event of my Death.
Name of the Address of the Nominee's Date of Birth Total Amount of Ifthe Nominee is minor, name,
Nomineel Nominees Relationship share of relationship and address of the
nominees with the accumulations in guardian who may receive the
member Provident Fund to be amount during the minority of
paid to each nominee. nominee
House Number Mother 13-Feb-1978 50
Sangeeta
Nagar 217, Ward 05
Pani Ki Tanki Ke
Pas, Near
Anand Vihar
Abhinandan
Main Colony,
Mandsaur (M.P),
Abhinandan
Main Colony,
Near Anand
Vihar Gate,
Mandsaur
458001, Madhya
Pradesh, India

20-0ct-2024 Page 1 of 3
 Mo of the Address of the Nominee's Date of Birth Total Amount of If the Nominee is minor, name,
Nomineel Nominees Rolationship share of relationship and address of the
nominees with the accumulations in guardian who may receive the
member Provident Fund to be amount during the minorityof
paid to each nominee. nominee
Arun Kumar House Number Father 15-Dec-1972 50
Nagar 217, Ward 05
Pani Ki Tanki Ke
Pas, Near
Anand Vihar,
Abhinandan
Main Colony,
Mandsaur (M.P),
Abhinandan
Main Cotony,
Near Anand
Vihar Gate,
Mandsaur
458001, Madhya
Pradesh, India
O1. Certified that I have nófamitly as defined in Para 2(g) of the Employees Provident Fund Scheme, 1952 and should I
acquire a family hereafter the above nomination should be deemed as cancelled.
2. Certified that my father/ mother is / are dependent upon me.

Signature of the subscriber/member

20-Oct-2024 Page 2of 3

 PART B (EPS)
(Para 18)
Serial No Name of the Family Address of the Family member Date of Birth Relationship with the
member member

Certified that Ihave no family, as defined in Para 2 (vi) of Employees Pension Scheme, 1995 and should l acquire a
family hereafter Ishall furnish particulars thereon in the above form.

Thereby nominate the following person for receiving the monthly widow pension (admissible under Para 16 (2)(a)(0) and
() of the Employees Pension Scheme, 1995 in the event of my deathwithout leaving any eligible family member for
receiving pension.
Name of the nominee Address of the nominee Date of Birth Relationship with the
member
Mr. Arun Kumar Nagar House Number 217, Ward 05, Pani 15-Dec-1972 Father
Ki Tanki Ke Pas, Near Anand Vihar
,Abhinandan Main Colony,
Mandsaur (M.P), Abhinandan Main
Colony, Near Anand Vihar Gate,
Mandsaur- 458001, Madhya
Pradesh, India
Ms. Sangeeta Nagar House Number 217, Ward 05,Pani 13-Feb-1978 Mother
(KiTanki Ke Pas, Near Anand Vihar
Abhinandan Main Colony,
Mandsaur (M.P),Abhinandan Main
Colony, Near Anand Vihar Gate,
Mandsaur- 458001, Madhya
Pradesh, India

Date: Qo|1o|20Q4 Signature of the suoscriber/member

CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed before me by Shri Smt.IKumariRIYA NAGAR inmy
establishment after he/she has read the ehtries have beeh read Over to him/her by me and got confimed by himher.

Date: Signature of the employer or

Other authorized Officer of the establishment

20-Oct-2024 Page 3 of 3
 Applicant ID: 2207787
Form 9 (Revised)
THE EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952
(Paragraph 34)
AND
THE EMPLOYEES' PENSION SCHEME, 1995 (Paragraph 24)
Declaration by a person taking up employment in an establishment in which the Employees
Provident Funds &Employeos' Pension Scheme enforce

I, Riya Nagar Daughter of Sh. Arun Kumar Nagar do hereby solemnly declare that:

(a) Iwas employed with NA, NA with PF Ac Number NA and left service on NA prior to that, Iwas employed in NA, NA with
PF Alc Number NA from NA to NA.

(b) Iam a member of the Pension Fund from NA to NA.

(c) I have withdrawn the amount of my Provident Fund. - NA

(d) Ihave withdrawn the amount of my Pension Fund. - NA

(e) Ihave drawn any benefits under the Employees Pension Scheme, 1995 in respect of my past service in any
establishment. - NA

)LhavÇ not contributed to the social security programme in NA from NA to NA, which has not entered into a Social
Security Agreement with India.

(g) Do you have a Universal Account Number (UAN): No

Universal Account Number Aadhar NPR PAN

NA 71934880-9542 NA CHPPN2029G
(h) Bank Account Number Linked with UAN:NA
Bank Account Number IFSC Code

NA NA

Date : Signature of employee

(To be filled by the employer)

1) Shi/SmtUKumari Riya Nagar is appointed as Systems Engineer in Tata Consultancy Services Limited, with effect from
07-NOV-2024 bearing Provident Fund Account Number: MHIBANI48475/000/

20-0ct-2024 Page 1of 2

 Tata Consutancy Services Limited
10th Floor, Air India Building, Nariman Point,
Mumbai 400 021.

20-0ct-2024
Page 2 of 2
 3TATR Government of Inda AADHAAR

T/INFORMATION
Government of India

Unique ldentification Authority of India

IH0cH HA/ Enrolment No.: 0515/25112/03132
To

Riya Nagar
DIO: Arun Kumar Nagar,
makan no.217..
ward no.05,,
paani ki tanki ke pass,
abhinandan main colony,
VTC: Mandsaur,
PO: Mandsaur,
Sub District: Mandsaur,
District: Mandsaur,
State: Madhya Pradesh, Aadhaar is proof of identity, not of citizenship or date of birth (DOB). DOB
PIN Code: 458001, is based on information supported by proof of DOB document specified in
Mobile: 9981647179 regulations, submitted by Aadhaar number holder.
This Aadhaar letter should be verified through either online
authentication by UIDAl-appointed authentication agency or QR code
scanning using mAadhaar or Aadhaar QR Scanner app available in
app stores or using secure QR code reader app available on
www.uidai.gov.in.
Sgnature Not Veriied Aadhaar is unique and secure.
Documents to support identity and address shoukd be updated in
Aadhaar after every 10 years from date of enrolment for Aadhaar.
Aadhaar helps you avail of various Govenment and Non
Government benefits/services.
Keep your mobile number and email id updated in Aadhaar.
3TT4T 3HTJTT hHiG/ Your Aadhaar No. : Download mAadhaar app to avail of Aadhaar services.
Use the feature of Lock/Unlock Aadhaar/biometrics to ensure
7193 4880 9542 security when not using Aadhaar/biometrics.
VID: 9153 7903 7584 6647
Entities seeking Aadhaar are obligated to seek consent.

Government of India Unique ldentification Authority of India

STOZLLS
fR R HV: HR R, HOH A.217,, a q.05,.
Riya Nagar
ffvDOB: 27/10/2001 Ag -458001
CEMALE Ad
Aress Kumar Nag nakan no.217..
ward no.05., paani ki tanki ke pass.
abhinandan main colony, Mandsaur, PO:
Aadhaar s proof of ldentity, not of citizenship EMandsaur, DIST: Mandsaur.
or date of birth, It should be used with verification (online Madhya Pradesh -458001
authentication, or scanning of QR code/ ofline XML).

7193 4880 9542

7193 4880 9542 VID : 9153 7903 7584 6647
1947 elpudai.gov.in | www.uldal.gov.in