DCRG Nomination Form

Nomination for Payment of Death-Cum-Retirement Gratuity (DCRG)

Employee Details

Employee Name (Mandatory)

Common Address for All Nominees

Full Address (Mandatory)

Original Nominee

Name of Nominee (Mandatory) Relationship with Employee (Mandatory) Age in Years (Numbers Only, Mandatory) Share Percentage (Numbers Only, Mandatory)

Alternate Nominee

Name of Alternate Nominee (Optional) Relationship with Employee (Mandatory if Name is Filled) Share Percentage (Mandatory if Name is Filled)

Total share percentage for nominees must equal 100%.