FORM 'F' Applicant ID: 2030419

See sub-rule (1) of

Gratuity Nomination Form
To,
TATA Consultancy Services Ltd,
9th Floor, Nirmal Building,
Nariman Point,Mumbai 400021.

1. I, ANKIT YADAV 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 direct that the said amount of
gratuity shall be paid in proportion indicated against the name(s) of the nominee(s).

2. I hereby certify that the person(s) nominated is/are a member(s) of my family within the meaning of clause (h) of Section
2 of the Payment of Gratuity Act, 1972. Yes

3. I hereby declare that I have no family within the meaning of clause (h) of Section 2 of the 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 Ms. Sunaina Devi Mother 05/07/1972 50

04, Shiv Mandir, Main Road
Gariyawas, Gariyawas,
Udaipur, Udaipur- 313001,
Rajasthan, India
2 Mr. Omprakash Yadav Father 09/07/1974 50
04, Shiv Mandir, Main Road
Gariyawas, Gariyawas,
Udaipur, Udaipur- 313001,
Rajasthan, India

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 Statement
Full Name: ANKIT YADAV Applicant ID: 2030419
Gender: M Date of Joining: 08-Aug-2024
Martial Status: Single Department: NA
Religion: NA
Permanent Address: 04, Shiv Mandir, Main Road
Gariyawas Gariyawas Udaipur
Udaipur Rajasthan 313001

Date:
Place: Signature of Employee:

DECLARATION BY WITNESSES
Nomination signed before me
SR No. Name in full and full Address of Witnesses Signature of Witnesses
1.
2.
Date : Place :

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 employer/trustee

ACKNOWLEDGEMENT BY THE EMPLOYEE

Received the duplicate copy of nomination in Form 'F' filed by me and duly certified by the employer.

Date : _________________ Signature of the employee :

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 Applicant ID: 2030419
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 & Employees' Pension Scheme enforce

I, Ankit Yadav Son of Sh. Omprakash Yadav do hereby solemnly declare that:

(a) I was employed with NA, NA with PF A/c Number NA and left service on NA prior to that, I was employed in NA, NA with
PF A/c Number NA from NA to NA.

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

(c) I have withdrawn the amount of my Provident Fund.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

(d) I have withdrawn the amount of my Pension Fund.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

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

(j) I have 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 6250-2017-2080 NA BAVPY5607F
(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) Shri/Smt/Kumari Ankit Yadav is appointed as Assistant System Engineer-Trainee in Tata Consultancy Services
Limited, with effect from 08-AUG-2024 bearing Provident Fund Account Number: MH/BAN/48475/000/ ________________

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

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 FORM - 2 Applicant ID: 2030419
Pension Number : MH/BAN/48475/____________

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(In Block Letters) : ANKIT YADAV

2. Father's /Husband's Name : Omprakash Yadav

3. Date of Birth : 18/12/1998

4. Male/Female : Male

5. Marital Status : Single

6. PF Account Number : MH/BAN/48475/______________

7. Address:

Permanent : 04, Shiv Mandir, Main Road Gariyawas Gariyawas Udaipur Udaipur Rajasthan 313001

Temporary : 04, Shiv Mandir, Main Road Gariyawas Gariyawas Udaipur Udaipur Rajasthan 313001

8. (a)Date of joining EPF Scheme,1952 : 08/08/2024

(b)Date of joining E.P.Scheme,1995 : 08/08/2024

___________________________________________________________________________________

PART - A ( EPF)
I hereby Nominate the person(s)/cancel 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 If the Nominee is minor, name,
Nominee/ 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
Sunaina Devi 04, Shiv Mandir, Mother 05-Jul-1972 50
Main Road
Gariyawas,
Gariyawas,
Udaipur,
Udaipur-
313001,
Rajasthan, India
Omprakash 04, Shiv Mandir, Father 09-Jul-1974 50
Yadav Main Road
Gariyawas,
Gariyawas,
Udaipur,
Udaipur-
313001,
Rajasthan, India

1. Certified that I have no family 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.

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 Signature of the subscriber/member

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 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 I have no family, as defined in Para 2 (vii) of Employees Pension Scheme, 1995 and should I acquire a
family hereafter I shall furnish particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension (admissible under Para 16 (2)(a)(i) and
(ii) of the Employees Pension Scheme, 1995 in the event of my death without leaving any eligible family member for
receiving pension.

Name of the nominee Address of the nominee Date of Birth Relationship with the
member
Mr. Omprakash Yadav 04, Shiv Mandir, Main Road 09-Jul-1974 Father
Gariyawas, Gariyawas, Udaipur,
Udaipur- 313001, Rajasthan, India
Ms. Sunaina Devi 04, Shiv Mandir, Main Road 05-Jul-1972 Mother
Gariyawas, Gariyawas, Udaipur,
Udaipur- 313001, Rajasthan, India

Date: Signature of the subscriber/member

CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed before me by Shri/ Smt./Kumari ANKIT YADAV in
my establishment after he/she has read the entries have been read over to him/her by me and got confirmed by him/her.

Date: Signature of the employer or

Other authorized Officer of the establishment

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