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Free form template · Word

Nominee Change Form

A nominee change form lets an employee replace or add nominees for employer-linked benefits such as gratuity, group term life insurance and other dues payable on death. It records the new nominees, their share and witnesses, and notes where statutory forms must also be filed.

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Preview of the form

[Highlighted] = fill in
[Company Logo][Company Name]

NOMINATION / CHANGE OF NOMINEE FORM

Employee Name:
[Employee Name]
Employee ID:
[Employee ID]
Date of Joining:
[Date of Joining]
Date:
[Date]

I hereby cancel my earlier nomination(s) for the benefits ticked below and nominate the following person(s).

  • Gratuity
  • Group term life insurance
  • Group personal accident insurance
  • Unpaid salary, leave encashment and other dues
  • Other: [Specify]
Nominee NameRelationshipDate of BirthAddressShare (%)Guardian (if minor)
[Name][Relationship][DD/MM/YYYY][Address][%][Guardian Name / NA]
[Name][Relationship][DD/MM/YYYY][Address][%][Guardian Name / NA]
[Name][Relationship][DD/MM/YYYY][Address][%][Guardian Name / NA]

Note: For Provident Fund, I will file or update my e-nomination through the EPFO member portal using my UAN.

Privacy notice: [Company Name] collects the details on this page only for paying benefits and dues to your nominees. Access is limited to authorised HR staff, and the record will be kept for the duration of employment and until all dues are settled, plus the retention period, after which it will be securely deleted or destroyed. You may ask HR to see or correct your data, consistent with the Digital Personal Data Protection Act, 2023.

Employee
[Employee Name]
Date: [Date]
Witness 1
Name: [Name]
Signature
Witness 2
Name: [Name]
Signature

Acknowledgement

Received the above nomination on [Date] and filed in the personnel file of [Employee Name].

[HR Name]
For [Company Name]

What this template includes

  • Benefit-wise nomination so each scheme is clear
  • Share percentage totalling 100 per cent
  • Guardian details for minor nominees
  • Witness signatures
  • Reference to statutory forms such as PF e-nomination
  • Acknowledgement by HR with date

When to use it

  • After marriage, when the spouse becomes a nominee
  • After the death of an existing nominee
  • When an employee wants to change share percentages
  • When a minor nominee needs a guardian named

How to customise this template

  1. 1List every benefit your company offers that needs a nominee
  2. 2Add your insurer's policy number
  3. 3Note that PF nomination is filed online by the employee through the member portal
  4. 4Use the statutory gratuity nomination format where your rules require it
  5. 5Keep a copy in the sealed section of the personnel file

HR tips

  • Check that shares add up to exactly 100 per cent
  • Record nominee contact only as much as needed to pay dues
  • Remind employees that nominations do not settle inheritance disputes
  • Acknowledge receipt in writing so the employee knows it is on file

Statutory nominations for PF, gratuity and similar benefits may need prescribed forms. Use this form alongside them and confirm requirements with your legal or compliance adviser.

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Frequently asked questions

Can I change my gratuity nominee?+

Yes. Submit a fresh nomination to HR; in many cases a nomination must be updated after marriage.

Does this form change my PF nominee?+

PF nomination is usually filed online through the EPFO member portal. HR can guide you, but this form alone does not change it.

Can a minor be a nominee?+

Yes, but you should name a guardian who will receive the amount on the minor's behalf.