2 FORM: PE -01 io 3 (Revised) EMPLOYEES” OLD-AGE BENEFITS qq INSTITUTION APPLICATION FOR EMPLOYEE'S REGISTRATION ‘ Sy yi sha 3 camlgt 1. Name (in block tetters) a8 shown In the National Identiy Card, Geese pe A eURL gt 2. Sex Me Zz viet 3, Father's / Husband's Name 6 oe fap a 4 Depots ECT TT etn 5. National ldenity Gard No. cI (Please enciose photocopy of both sides) z = MEISE? 5.A Nadra National identity Card No. = Feiss 5.8 Family Code HEEtrEr i Pre, Mesoot adroos eee Permenant Address. * Ceortiicate of Employer urea Worker's Signature / feat 7. Employment ofthe above employee began on sees duads 8. Date of applicabitiy of the scheme mye 9. National identity Card checked and details, ‘shown on this form are certiled correct é tne LM ne LIAS SUG VSL 10, Namo of establishment, heme Registration No. = a ae Seat of the. PSiaststenone Date. a be eee FOR OFFICE USE ONLY Worker's Thumb Impression/oS Ket yy CCOOTTIT cos” Singnature of Employer a.zt Name- i Designation: od Bours £08! Registraton Gard No. [TILT PRANTL 18) P1083 issuedinot issued nb go ploy rm F-01.8m [1072572007 12012 4)