Full Name: Mr. /Ms. / Mrs.
Personal Contact Number:
Personal E-mail ID:
Qualification (Mention your highest qualification):
Date of Birth:
Place of Birth:
Blood Group:
Height(cm):
Weight(Kg):
Father’s Name:
Mother’s Name:
Marital Status: SingleMarried
Date of Marriage:
No. of Dependents:
Nationality:
Languages Known:
Hobbies:
Personal Aliments / Handicaps, if any:
PAN Card No.:
Aadhar Card No.:
Driving License No.:
Passport No.:
Date of Issue:
Valid Up to:
Permanent Address:
Present / Correspondence Address:
Res. (Tele.) Permanent:
Present:
Mobile Permanent:
Sr. No.
Name of the member
Relation (Spouse=S, Child=C)
Date of Birth
1
2
3
I hereby nominate the below mentioned person to claim my amount in case of my Death:
Name of Person
Contact No.
Relationship
Address
Name:
Relation:
Contact No:
Address:
Date:
Employee Signature:
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