Social Security Form VI: application for gratuity direction

Application to the competent authority where the employer has not paid the gratuity claimed or the amount is disputed.

(See rule 33(4) · Social Security (Central) Rules, 2026 · Central-sphere scope

Download and read the completed example

Completed fictional application for gratuity direction for Sahyadri Illustration Services Pvt Ltd (fictional), 14 Example Park, New Delhi 110001. It illustrates the prescribed fields without executing a signature or official act.

Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.

When and how this form is used

Rule 33(4) uses this application and annexure for the gratuity dispute. Identify the employer response, service particulars, amount already paid or offered and the precise balance sought.

The underpayment illustration is an alternative case to the full-admission Form V example. It does not assert that the same employer both paid the full amount and withheld it.

The completed fields

Proceeding and annexure particulars

Prescribed field / section	Completed fictional entry
Before / application number	Competent authority having jurisdiction over the fictional Central-sphere establishment in New Delhi; no real case number or office order is represented; number NOT ASSIGNED
Employee / applicant	Arun Mehta (fictional), 8 Example Lane, New Delhi 110001; employee retirement route; married
Employer	Sahyadri Illustration Services Pvt Ltd (fictional), 14 Example Park, New Delhi 110001
Department / post / dates	Finance; accounts officer; joined 1 October 2016; retired 30 September 2026; 10 completed years
Last relevant monthly wages	₹52,000
Claim basis / share / amount	Retirement gratuity; 100%; ₹3,00,000 total
Claim and disputed notice	Form IV dated 5 October 2026; alternative hypothetical employer notice dated 10 October offered only ₹2,50,000
Death / nomination / succession evidence	N/A; living employee applying personally
Dispute and prayer	Employer used an unexplained ₹2,50,000 calculation. Applicant asks determination of ₹3,00,000 and payment of the ₹50,000 shortfall, with any interest determined under the law.
Earlier steps / grounds	Claim and employer response indexed; no allegation of death or nominee dispute
Place / date / verification	New Delhi, 20 October 2026; applicant verifies fictional facts; Signature / seal / certification not executed; typed name is an illustration only

Supporting records and reconciliation

Attach the actual claim, employer notice/refusal, service/wage records, proof of any payment, computation and any delay explanation required by the actual procedural dates.

Worked calculation: ₹3,00,000 claimed − ₹2,50,000 offered = ₹50,000 disputed shortfall.

Official source and version

Official Gazette, Social Security (Central) Rules, 2026; Form VI; PDF pages 213–214

Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.

The Central Rules have their stated jurisdiction. The corresponding appropriate-government rules and any later amendment must match the real establishment and event.

Practical questions

Can I submit the sample as my own completed form?

No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.

What makes the example specific to this form?

This is the prescribed application for gratuity direction under (See rule 33(4), with its own parties, event, required entries and legal function.