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Pension Regulation Army 2008 Part - I

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II
(To be filled by the Commanding Officer in the case of PBOR) Appendix IX
Nomination by:____________________ (Referred to in Regulation 145(a)(2))
Designation:__________________
Office: ______________________ FORM 'B'

Signature of Commanding Officer Nomination for Retirement Gratuity/Death Gratuity
Name: When the individual has no family and wishes to nominate one person or more than
Designation: one person
Date: I, No.________________ Rank ______Name ______________, having no family,
hereby nominate the person/persons mentioned below, and confer on him/them the right to
receive, to the extent specified below, any gratuity the payment of which may be
authorised by the Government in the event of my death while in service and the right to
Proforma for acknowledging the receipt of the nomination from receive on my death, to the extent specified below, any gratuity, which having become
admissible to me on retirement may remain unpaid at my death:
To.
_______________________ Original nominee(s) Alternate nominee(s)
_______________________ Name & Relationship Age Amount or share Name, Address, Relationship & Age Amount or
_______________________ Address of with the of gratuity payable of the person or persons, if any, to share of
nominee/nomi individual to each* whom the right conferred on the gratuity
nees nominee, pre-deceasing the individual payable to
Sir, or the nominee dying after the death of each**
In acknowledging the receipt of your nomination/cancellation, dated the individual but before receiving
payment of the gratuity
the_________________ of the nomination made earlier, in respect of gratuity in Form 'A',
I am to state that it has been duly placed on record.
(1) (2) (3) (4) (5) (6)
Place:________________
Dated the:______________

Signature

Designation___________

Note: The individual is advised that it would be in the interest of his nominees if copies This nomination supersedes the nomination made by me earlier on
__________________________________which stands cancelled.
of the nominations and the related notices and acknowledgements are kept in safe

custody so that they may come into the possession of the beneficiaries in the event
of his death. Note:(i) The individual should draw lines across the blank space below the last entry
to prevent the insertion of any name after he has signed.
(ii) Strike out which is not applicable.
Dated This _____day of _____________20__ at _______________

Witnesses to signature1._____________________

2. _____________________
Signature of individual

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