Self

Name

Staff No.*

Date of Joining

* To be filled in by the Human Resources Department

Spouse

Name as per passport

Date of Birth

Passport No. Place of Issue Date of Issue Date of Expiry

Children

Sr.

No.

1

2

3

4

5

6

Parents / Brothers / Sisters

Sr.

No.

1

2

3

4

5

6

7

8

9

Nomination of Beneficiary

Name as per passport

Family / Surname

Date of Birth Gender

Job Title

Nationality

Nationality

SELF & FAMILY DETAILS

Name as per passport Date of Birth Passport No.

Please fill in the name and address of the beneficiary. In case you wish to nominate more than one beneficiary, please indicate

percentage of distribution of full and final settlement of dues

Title

Department Section

Date of ExpiryDate of Issue

Date of Expiry

Middle

Relation Nationality Date of Issue

Passport No.

Date

( Signature )

Name

Address

Relationship

Percentage Percentage

Name

Address

Relationship

Tel Tel