FORM "A" OF NOMINATION WHEN THE SUBSCRIBER HAS A FAMILY
APPENDIX “A” FROM “A” OF NOMINATION WHEN THE SUBSCRIBER HAS A FAMILY
I hereby declare that in the event of my death the amount at my credit in the Provident Fund established under the Gujarat Medical Council Rules 1969, shall be distributed among the member of my family mentioned in column 1 in the manner shown against their names. The amount due to a nominee who is a minorat the time of my death shall be paid to the person whose name appears in column 5.
Name and address of the nominee or nomination
Relationship with the sub-scriber
Age of the Nominee
Amount or share of accumulations
Name and address of the person to whom payment is deconbehalf of the minor.
1
2
3
4
5
Dated the ___________ day of _________ 19____________ at Witness
