NPS: FORM 2 – Common Nomination Form for Gratuity and CGEGIS

FORM 2 – Common Nomination Form for Gratuity and CGEGIS

FORM 2
Common Nomination Form for Gratuity and Central Government Employees’ Group Insurance Scheme
( See rule 23)

I, ______________________________, hereby nominate the person/persons mentioned below and confer on him/her/them the right to receive in the event of my death, to the extent specified below, amount on account of the following:

i. any gratuity the payment of which may be authorised under rule 22 of Central Civil Services (Payment of Gratuity under National Pension System) Rules, 2021,

ii. any amount that may be sanctioned by the Central Government under the Central Government Employees Group Insurance Scheme, 1980

Name, date of birth (DOB) and address of the nominee	Relation- ship with employee/ pensioner	Share to be paid to each	If nominee is minor, name, DOB and address of person who may receive the amount on behalf of minor	Name, DOB, relationship and address of alternate nominee in case the nominee under Column (1) predeceases the employee	Share to be paid to each	Name, DOB and address of person who may receive the amount if alternate nominee in Col. (5) is a minor	Contingency on happening of which nomination shall become invalid
1	2	3	4	5	6	7	8

These nominations supersede any nominations made by me earlier.

Place and date:

Signature of Government servant

Mobile No_______________________

Note 1 : Completely strike out the benefits for which nomination is not intended to be made. Separate copies of this nomination Form may be used for nominating different persons for benefits (i) and (ii) above.

Note 2 : The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he/she has signed.

Note 3 : The nominee(s)/alternate nominee(s)’ shares together should cover the whole amount.

(To be filled in by the Head of Office/authorised Gazetted Officer)

Received the nominations, dated _______________, under the following rules :—

1. Central Civil Services (Payment of Gratuity under National Pension System) Rules, 2021 for Gratuity.

2. Central Government Employees Group Insurance Scheme, 1980. made by

Shri/Smt./Kumari :_____________________
Designation: __________________________
Office: ________________________________

(Strike out which nomination is not received)

Verified that the nomination(s) made by the Government servant is/are in accordance with the provisions of the relevant rules. Entry of receipt of nomination(s) has been made in page _____________ Volume ____________ of Service Book.

Name, Signature and Designation of Head of Office/authorised Gazetted Officer with seal

Date of receipt _____________________

The receiving officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his/her death.

The receiving officer shall put his/her dated signature on both pages of this Form.