Attached is the format needs to be filled.
Wherein on the front page, the Name & Address of the Establishment, Name of the Employee in full as well as the Nominees details need to be furnished.
Clause no. 5 need not be filled. The no. of nominations depends & can be either spouse, father &/or mother with % proportionately shared.
In page 2, the details of the employee need to be furnished along with the signature. Also, the details & signature of the witnesses are must.
In page 3, only the acknowledgement needs to be signed by the employee.
Certificate by the employer needs to be filled up by the organisation.