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Annexure I

FORM: PE-01
(Revised)

EMPLOYEES
OLD-AGE BENEFITS
INSTITUTION
APPLICATION FOR EMPLOYEES REGISTRATION
1

Name (In block letters)


as shown in the National Identity Card

Gender

2A

Handicapped

yes

No

2B

Nature of Disability*
(Only if 2A is
Checked as Yes)

Visual

Hearing

Male

Female

Speaking

Limbs

Other
(Please specify)

Father (F)/Husbands (H) Name


Day Month

Date of Birth

In words
National Identity Card No.

F
Year

5A

NADRA National Identity Card No.


(Please attach photocopy of both sides)

5B

Family Code

Present
Address

(Please check one)

Permanent
Address
CERTIFICATE OF EMPLOYER
Day Month

Year

Employment of above employee began on


Workers thumb impression

Date of the applicability of the scheme

National Identity Card inspected and details


Shown on this form are certified correct

10

Name of establishment

Workers Signature

Registration No.

Sub Code if any

Seal of the
Establishment

Signature of Employer
Name
Designation

Day Month

Year

Date
FOR OFFICE USE ONLY
EOBI Registration Card No.
Initial

Day Month

Year

Day Month

Year

Contribution Card Issued


P103 Issued/ Not Issued
*Attach certificate from Provincial council for the Rehabilitation of Disabled Person

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