FORM OF APPOINTMENT OF BENEFICIARY UNDER RULE 24 OF THE

TATA CONSULTANCY SERVICES EMPLOYEES SUPERANNUATION FUND

Employee Number: XXXXX Employee Name: XXXX

Father’s/Husband’s Name: XXXXX Date of Birth: 17/06/1973
Gender: Female Marital Status: Single
Depute Branch: TCS - Chennai Location: Infopark -SEZ

To, Sample Print Out

TATA Consultancy Services Ltd,
9th Floor, Nirmal Building,
Nariman Point, Mumbai 400021.
If you are
unmarried, Mention Employee Full Name
Dear Sirs,
you can
nominate I, XXXXXXXX of TATA CONSULTANCY SERVICES hereby appoint in terms of Rule 24 of the above Fund headed
your “Appointment of Beneficiary”, the person/ persons named in the first column below to receive the moneys payable
dependent under the Rules of the Fund in the event of my death, in the proportions stated against their names.
parents. If
your parents I also request the amount payable to the minor(s) be paid to the guardian named in the column below.
are deceased, Nominees Relationship
Name and address of Name and Share of
you can relationship of guardian
nominee or Date of Birth address of the money
nominate with with minor
nominees Guardian payable
your brother, employee nominee
sister or any Mr. XXXXXXXXX XXXX
person as – 600044 Father 18/06/1940 100
your Tamil Nadu, India
Nominee.
1. Certified that I have no family and should I acquire a family hereafter, the above nomination should be
deemed as cancelled.
2. Certified that my father/mother/sister(s) /minor brother(s) is/are dependent upon me.
Signed on 15-May-15 at Mumbai.
Sign here
__________________________
Select point 1 or 2,
appropriately as applicable. Signature of the Member
Witness:
I. (1) Signature: II. (1) Signature:
(2) Name: (2) Name:
(3) Address: (3) Address:

Certified that the above appointment of Beneficiary/ Nominee has been signed by XXXXXXX before me after he/she
has read the entries, the entries have been read to him/her by me and that the appointment of Beneficiary/ Nominee
is recorded under the Fund.
Do not sign here

Date: 15-May-15 _____________________

Signature of Trustee/s

FOR SELF AND CO-TRUSTEES OF

TATA CONSULTANCY SERVICES
EMPLOYEES SUPERANNUATION FUND