FORM NO. 40B
[See rule 67A/rule 101A*]
Form for modifying nomination
………………………………..………..Provident Fund/ ………………………………….Gratuity Fund*
[name of fund]
[name of fund]
Account No. ………………………………….
I, ……………………………………………………………….……………. hereby cancel the nomination made by me
in the event of
previously as regards the disposal of the *amount that may stand to my credit in the provident fund
*amount of gratuity
my death and hereby nominate the person(s) mentioned below to receive the
*amount that may stand to my credit in the provident fund
in the event of my death before that amount becomes payable,
*amount of gratuity
or having become payable, has not been paid, and direct that the said amount shall be distributed among
the said person(s) in the manner shown against their names:
Name and address of Nominee’s relationship Age of nominee *Amount or share
nominee or nominees with the employee
of accumulations
in the provident
fund/*amount
or share of
gratuity to be
paid to each
nominee$
1
2
3 4
*1. Certified that I have no family and should I acquire a family hereafter, the above nomination should
be deemed as cancelled.
*2. Certified that my father/mother/sister(s)/minor brother(s) is/are dependent upon me.
Dated this …………………………………. day of ………………………………..………. at ………………..
Two witnesses to signature
………………………………
Signature of employee
1.
2.
Certified that the above declaration has been signed before me by Shri/Shrimati ………………………………….
Date ………………..
…………..……………………
Signature of the trustee or any
person authorised by the
trustees in this behalf
*Delete the inapplicable words.
$ This column should be filled in so as to cover the whole of the amount that may stand to the credit of the
employee in the provident fund or the whole of the amount of gratuity that may be payable in the event of
his death.