The Social Security (Central) Rules, 2026

Rule Form V Form V

Chapter: Annexures · Forms and Appendices
Text as on: As notified 08 May 2026

FORM-V [(See rule 33(2)] Notice for payment/rejecting claim of gratuity (Strike out the words not applicable)

To,..................................................................................................................... ..................................... (Name and address of the applicant employee/nominee legal heir)

You are hereby informed that

(a) *as required under sub-clause (ii) of clause (a) of sub-rule (2) of rule 33 of the Social Security (Central) Rules, 2026, that your claim for payments of gratuity as indicated on your application in Form-IV under the said rules is not admissible for the reasons stated below:

Reasons (Here specify the reasons); or

(b) *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 33 the Social Security (Central) Rules, 2026 that a sum of Rs. ...........(Rupees.....................) is payable to you as gratuity/as your share of gratuity in terms of nomination made by ....................on

.....................and...............recorded in this .....................as a legal heir of......................an employee of this establishment.

2.*Please call at ..........................on.............................. (Here specify place)..........................(date) at...................(time) for collecting your payment of gratuity crossed cheque.

3. Amount payable shall be sent to you through demand draft or shall be credited in your bank account as desired by you.

4. Brief statement of calculation

a. Date of appointment. b. Date of termination/superannuation/resignation/ disablement/death. c. Total period of service of the employee concerned: ......................years....................

months.

(d) Wages last drawn:

(e) Proportion of the admissible gratuity payable in terms of nomination/as a legal heir:

(f) Amount payable:

*strike out para, if not applicable

Place:

Date: Signature of the Employer/Authorised Officer.

Name or description of establishment or

rubber stamp thereof.

Copy to:

The Competent Authority.

FORM-V
[(See rule 33(2)]
Notice for payment/rejecting claim of gratuity
(Strike out the words not applicable)

To,.....................................................................................................................
.....................................
(Name and address of the applicant employee/nominee legal heir)

You are hereby informed that

(a) *as required under sub-clause (ii) of clause (a) of sub-rule (2) of rule 33 of the Social Security
(Central) Rules, 2026, that your claim for payments of gratuity as indicated on your application in
Form-IV under the said rules is not admissible for the reasons stated below:

Reasons (Here specify the reasons); or

(b) *as required under sub-clause (i) of clause (a) of sub-rule (2) of rule 33 the Social Security
(Central) Rules, 2026 that a sum of Rs. ...........(Rupees.....................) is payable to you as
gratuity/as your share of gratuity in terms of nomination made by ....................on

.....................and...............recorded in this .....................as a legal heir
of......................an employee of this establishment.

2.*Please call at ..........................on.............................. (Here specify
place)..........................(date) at...................(time) for collecting your payment of
gratuity crossed cheque.

3. Amount payable shall be sent to you through demand draft or shall be credited in your bank
account as desired by you.