Rajesh Bansal
House No. 214, Sector 15-A, Chandigarh 160015
Date: 2 April 2026
To,
The Head of Human Resources
Northline Analytics Private Limited
Plot No. 8, Phase 8-B, Industrial Area, S.A.S. Nagar (Mohali) 160055
Sub: Nomination for gratuity and provident fund (Employee ID NA-0231)
Dear Sir/Madam,
I, Rajesh Bansal, son/daughter/wife of Mohan Lal Bansal, working with Northline Analytics Private Limited as Field Sales Executive since 1 April 2026, provident fund number (UAN) 100123456789, give you the following declaration.
- 1. MY FAMILY. Wife Sunita Bansal (38), son Aarav Bansal (9), mother Meena Bansal (66). I have no other dependants.
- 2. MY NOMINEES. I nominate the following persons to receive the gratuity and the provident fund and any other amount payable by the Company or the Fund on my death, in the shares shown:
(a) Sunita Bansal, wife, 38 years, share 50 percent.
(b) Aarav Bansal, son, 9 years, share 25 percent.
(c) Meena Bansal, mother, 66 years, share 25 percent.
The shares add up to one hundred percent.
NOMINEE WHO IS A MINOR. Where a nominee is a minor, the money for that nominee may be paid to Sunita Bansal, mother of Aarav, an adult who will hold it for the child.
- 3. PRESCRIBED FORMS. I understand that this letter is my covering declaration only. The Company's gratuity nomination and the provident fund nomination must also be made in the form or process that the Company and the Provident Fund office prescribe, and I will complete and sign those forms, and the online nomination where the Fund asks for it, as soon as they are given to me. Please send me the current forms.
- 4. FAMILY NOMINEES. I understand that, where I have a family, the nominees must be members of my family as the rules provide, and that a nomination that does not meet the rules may not be given effect.
- 5. CHANGES. I will tell the Company in writing, and make a fresh nomination in the prescribed form, if my family changes by marriage, birth, death or otherwise, or if I wish to change my nominees. I understand that a nomination does not by itself decide who owns the money, and that it does not replace a will.
- 6. The particulars above are true and complete to the best of my knowledge.
Yours faithfully,
_________________________
Rajesh Bansal
Place: S.A.S. Nagar (Mohali)