Declaration
I, Vedika Rajkumar Paigwar
Employee ID: -1
Career Level & Designation: 12
Location: Hyderabad
Do hereby confirm my willingness to work in any shift including night shift. I am aware that the shift
times are subject to change and I agree to adhere to the same.
I also hereby confirm that I am aware of the Accenture Transport Policy and the provision whereby
home pick-up and drop facility is provided to women employees working during night shifts,
accompanied by either a security guard or a male employee as applicable. I am also aware of the
Accenture Transport helpline numbers which I can call in case of any emergency.
Signature:
Date: 22/07/2024
GF_ -1
Form ‘F’
Nomination under Payment of Gratuity Act, 1972 [Rule 6(1)]
The Trustees
Accenture Employees Group
Gratuity cum Life Assurance scheme.
VEDIKA Father
Father: RAJKUMAR PAIGWAR
Name Name/ Sur
Husband RAJKUMAR PAIGWAR Name
Name
Sex Employee
FEMALE Code -1
Religion Martial
HINDU Status
single
Date of
11/01/1998
Permanent HYDERBAD
Birth Address:
Date of Joining 22/07/2024
I hereby nominate the person(s) mentioned below to receive the gratuity payable after my death as also the gratuity standing to
my credit in the event of my death before that amount has become payable, or having become payable has not been paid and
direct that the said amount of gratuity shall be paid in proportion indicated against the names(s) of the nominee(s).
Sr.No Name in Full with full address of Relationship with the Age of Proportion by
Nominee/s Employee Nominee/s which Gratuity will
be shared
1 ZINGABAI TAKLI, GANPATI 56 100
NAGAR,NEAR MAHARAN 1 , NAGPUR FATHER
2. I have no family and should I acquire a family hereafter, the above nominations shall be deemed to be cancelled and fresh
nominations in favor of one or more of my family members shall be provided by me.
3. I hereby certify that the person(s) mentioned is a/are member(s) of my family within the meaning of clause (h) of section 2 of
the payment of Gratuity Act, 1972.
4. I hereby declare that I have no family within the meaning of clause (h) of section 2 of the said Act.
5. (a). I hereby certify that my father/mother/parents is/are not dependent on me.
(b). My husband's father/mother/parents is/are not dependent on my husband.
6. I have excluded my husband from my family by a notice dated ………to the controlling authority in terms of the proviso to clause
(h) of section 2 of the said Act.
7. Nomination made herein invalidates my previous nomination.
• Strike out the words/paragraphs not applicable..
22 day of _____
Dated this _____ 2024 at__________
07 _____ HYDERABAD
Declaration By Witnesses
Nomination signed/thumb impressed before me.
Name in full and full address of witnesses Signature of witnesses
1.__________________________________ 1. __________________________________
2.__________________________________ 2. __________________________________
Place: _______________________________ Date: _________________________________
Signature of Employee
CERTIFICATE BY THE EMPLOYER
Certified that the particulars of the above nomination & declaration have been verified and recorded in the establishment.
Place:
Signature of the Trustee/Authorised person
Date: For Self and co-Trustees of Accenture
______________________ Employees Group Gratuity cum Life Assurance scheme.
ACKNOWLEDGMENT BY THE EMPLOYEE
Received the duplicate copy of Nomination in Form F filed by me and duly certified by the Employer.
Place:
Date: Signature of Employee
______________________
GF_ -1
