NPS: FORM 9 – Application for the Grant of Death Gratuity

FORM 9 – Application for the Grant of Death Gratuity

FORM 9
Application for the Grant of Death Gratuity
[See rule 48 ]

(To be filled in separately by each claimant and in case the claimant is minor, the form should be filled in by the guardian on his/her behalf. Where there are more than one minor and one guardian for all of them, the guardian should claim gratuity in one Form on their behalf)

1. Details of deceased Government servant:

Name and designation		Date of death	DD/MM/YYYY
Office/Department/Ministry in which the deceased served last

2. Details of claimant(s):

Sl. No.	Name	Date of birth (DD/MM/YYYY)	Share	Relationship with the deceased Govt. servant	Postal address
1.
2.
3.

3. In case the claimant(s) is/are minor or suffering from disorder or disability of mind, including mental retardation, details of guardian:

Name	Date of birth (DD/MM/YYYY)	Share	Relationship with the minor/mentally disabled	Relationship with the deceased Govt. Servant	Postal address

4. Details of bank:

Bank’s Name

A/c No.

IFS Code

Place:
Date:
Mobile no.:

(Signature of the claimant/guardian)
________________________________________

Enclosure:

a. Death certificate.

b. Guardianship Certificate/ Indemnity Bond and Date of Birth Certificate in case the claimant is a minor.

c. Guardianship Certificate/ nomination and Medical Certificate in case the claimant is mentally disabled.