FORM 27 (see Rule 155) NOMINATION FOR PAYMENT OF PAY DUE FOR PERIOD OF HOLIDAYS IN THE EVENT OF DEATH OF WORKER I hereby require that in the event of my death before resuming work, the balance of my pay due for the period of holidays shall be paid to _____________________________________________ who is my ____________________________________________________________________________ and resides at __________________________________________________________________________ Witnesses: Attested Signature Signature or left hand Designation thumb impression of worker : - Address Signature Particulars or worker such as serial number Name in the register of adult/ child Designation workers Section or address Department, etc:- Date :
