FORM 'R'

[See Rule 17]

Notice For Payment Of Gratuity

To

................................................... [Name and address of employer]

Whereas Shri/Smt/Kumari ........................ of ................... (address) an [employee under you/a nominee(s) legal heir(s) of late ................... and employee under you, filed an application under section 7 of the Payment of Gratuity Act, 1972 before me;

And whereas the application was heard in your presence on and after the hearing I have come to the finding that the said Shri/Smt./Kumari ....................... is entitled to a payment of Rs .......... as gratuity under the Payment of Gratuity Act, 1972;

Now, therefore, I hereby direct to pay the said sum of Rs .................... to Shri/Smt./Kumari ...........................within thirty days of the receipt of this notice with an intimation thereof to me.

Given under my hand and seal, this .................. day of .............. 20 .........

Controlling Authority

Copy to:

(Applicant) He is advised to contact the employer for collecting payment.