First Schedule
[See rule 8(3)]
FORM OF NOMINATION
GPF Account No. ..........................., I, ................................................................ hereby nominate the
person(s) mentioned below who is/are member(s)/non-member(s) of my family as defined in rule 2
of the General Provident Fund (West Bengal Services) Rules, to receive the amount that may stand
to my credit in the Fund as indicated below, in the event of my death before that amount has
become payable or having become payable has not been paid.
Name and full address of the Relationship with Age of the Share payable to
nominee(s) the subscriber Nominee(s) each nominee
Contingencies on the Name, address and relationship of If the nominee is not a
happening of which the the persons(s), if any, to whom member of the family as
nomination will become invalid the right of nominee shall pass in provided in rule 2, indicate
the event of his/her predeceasing the reasons.
the subscriber
Dated this ............................... day of .....................20...... at ..................................
Two witnesses for signature.
Name and address Signature
1.
2.
Signature of the subscriber………………………………….
Name in Block Letters ………………………………………….
Designation……………………………………………………………
Space for use by the Head of Office
Nomination by Shri/Smt./Kumari ...........................................................
Designation .......................................
Date of receipt of nomination ...........................
Signature of Head of Office .........................
Designation ......................................
Date ..................................
(2)
Instructions for the subscribers:
(a) Your name may be filled in.
(b) Name of the fund may be completed suitably.
(c) Definition of term “Family”, as given in the General Provident Fund (West Bengal Services)
Rules, is reproduced below:
Family means:
(i) In the case of a male subscriber, the wife or wives and children of a subscriber and
the widow or widows, and children of a deceased son of the subscriber. Provided
that, if a subscriber proves that his wife has been judicially separated from him or
has ceased under the customary law of the community to which she belongs to be
entitled to maintenance, she shall thenceforth be deemed to be no longer a member
of the subscriber’s family in matters to which these rules relate, unless the
subscriber subsequently indicates by express notification in writing to the Accounts
Officer that she shall continue to be so regarded;
(ii) In the case of a female subscriber, the husband and children of a subscriber, and the
widow or widows and children of a deceased son of a subscriber. Provided that if a
subscriber by notification in writing to the Accounts Officer expresses her desire to
exclude her husband from her family, the husband shall thenceforth be deemed to
be no longer a member of the subscriber’s family in matters to which these rules
relate, unless the subscriber subsequently cancels formally in writing her notification
excluding him.
Note 1. “Children” means legitimate children.
Note 2. An adopted child shall be considered to be child when the Accounts Officer, or if any doubt
arises in the mind of the Accounts Officer, the solicitor to the Government of West Bengal
is satisfied that under the personal law of the subscriber, adoption is legally recognized as
conferring the status of a natural child, but in this case only.
(d) Col. 4- If only one person is nominated the words “in full” should be written against
the nominee. If more than one person is nominated, the share payable to
each nominee over the whole amount of the Provident Fund shall be
specified.
(e) Col. 5- Death of Nominee(s) should not be mentioned as contingency in this column.
(f) Col. 6- Do not mention your name.
(g) Draw a line across the blank space below last entry to prevent insertion of any name
after you have signed.
Note: A nomination shall become invalid in case a subscriber, who had no family at the time of
nomination, subsequently acquires a family.
By order of the Governor
Sd/-
Secretary to the Govt. of West Bengal
