LARSEN & TOUBRO OFFICERS AND SUPERVISORY STAFF
PROVIDENT FUND Psno : 40017310 █▀▀▀▀▀█ █▀▀█ ▄▀▀▀▄▀█▀ █▀▀▀▀▀█
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NOMINATION FORM Request No. : 22WF12028882 █ ▀▀▀ █ █▄▄▀█▀▀▀▄▀▀█▀ █ ▀▀▀ █
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Mobile No. : 9492656443
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(Rule 26 and 27) Form No.2 ▀▀▄█ ▀▀█▄█▀▄█▀▄▀ ▀█▀█▄▀▄▀▄▀▄█
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FULL NAME IN CAPITAL LETTERS DEPT. NAME DEPT. CODE
MARAPAREDDY RAMOHANA REDDY 1331TET 1331TET
SEX RELIGION MARITAL STATUS (Married, Unmarried, Widow, or Widower) DATE OF BIRTH
Male HINDUISM Unmarried Jun 5 1991
PERMANENT ADDRESS
1/605 -skpalem sunkalamma palem
I, hereby nominate the person(s) mentioned below to receive the amount that may stand to my credit in the Fund. In the event of my death before
that amount becomes payable, or having become payable, has not been paid and direct that the said amount shall be distributed among the said
persons in the manner shown below against their names :
PAYSHEET NUMBER LOCATION REGION
40017310 BANGALORE L&T TECHNOLOGY SERVICES
SLNO NAME & ADDRESS OF THE NOMINEE RELATION SHARE % Age of EMPLOYEE'S F/H CODE #
OR NOMINEES (UPTO 3 Nos.) DESC * Nominee FATHER'S/HUSBAND'S NAME
1 M RANGA REDDY FATHER 100 66 RANGA REDDY MARAPAREDDY F
-1/605,sunkalamma palem,Tadipatri, Ananthapur,AP, TADPATRI
# In this column fill either F or H Codes where F = Father & H = Husband
* This column should be filled in so as to cover the whole of the amount that may stand to the credit of the member in the Fund which is payable in the event of his
death.
Please refer definition of "Family" on Page 2.
-1- P.T.O
I hereby direct that in the event of my death during the minority of my above named nominee, the person whose particulars are given below shall be
deemed to be the guardian of the minor nominee for the purpose of Rule27 of the Fund.
Name & Address of the guardian Relationship of the Guardian with the member
Delete if not necessary: 1. Certified that I have no family and should I acquire a family here-after, 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 : Oct-25-2021 (Signature of the member)
Name and signature of two witnesses: 1. Signature 2. Signature
Name ___________________________ Name __________________________
Certified that the above declaration has been signed before me by Shri/Shrimati _____________________________________________
after he/she has read the entries/the entries have been read over to him/her by me.
Dated _________________ _________________________________________________________________
(Signature of the Trustee or any person authorised by the Trustee in his behalf )
N.B.: For the purpose of Rule 26 and 27," Family" means the employee's spouse ,his legitimate children and step children and dependent
parents ,sisters and minor brothers.
-2-
