GROUP LIFE INSRANCE WAPDA EMPLOYEES

FORM OF NOMINATION
(When the member has a family)

I, ____________________________ born on _________________ S/O _________________ hereby nominates the

person(s) mentioned below who is / are member(s) of my family as defined in rule 2 of the Pakistan WAPDA Employees
provident Fund Rules, to receive in the event of my death during my service with Pakistan WAPDA, amount that may be
admissible to my family under the Group Life Insurance Scheme of WAPDA employees in the manner shown against his/
their name(s).

I, hereby appoint the person(s) recorded in column-5 to receive the benefit available under Group Life Insurance Scheme
on behalf of Nominee(s) who is/ are suffering from legal disability.

Name & Address of the Relation with Whether major Percentage of Name & address Sex &
nominee(S) the employees or minor or share to be of the person to percentage or
suffering from paid to each whom payment is person
legal disability to be made on mentioned in
or major state behalf of the column-5
his/her age minor or the
person suffering
from other legal
disability
1 2 3 4 5 6

Dated: This _____________ Days of ____________________ at Mangla.

Designation: __________________________________ Signature of employee

Present Official __________________________________ Note – Nomination forms without the date
Address __________________________________ of birth of the employee will not be
Permanent ___________________________________ Entertained
Address ___________________________________

Two witness to signature of the member who must sign in the presence of other and in that of the member all being
present at the same time.

1. Signature _______________________
Address: _______________________
_______________________
Designation:________________________

2. Signature _______________________
Address: _______________________
_______________________
Designation:________________________
 Drawing and Disbursing Officer
GROUP LIFE INSRANCE WAPDA EMPLOYEES
FORM OF NOMINATION
(When the member has no family)
I, Umar Bin Sohail born on 08.02.1993 S/O Sohail Iqbal Mughal hereby nominates the person(s) mentioned below
who is / are member(s) of my family as defined in rule 2 of the Pakistan WAPDA Employees provident Fund Rules, to
receive in the event of my death during my service with Pakistan WAPDA, amount that may be admissible to my family
under the Group Life Insurance Scheme of WAPDA employees in the manner shown against his/ their name(s).

I, hereby appoint the person(s) recorded in column-5 to receive the benefit available under Group Life Insurance Scheme
on behalf of Nominee(s) who is/ are suffering from legal disability.

Name & Address of the Relation with Whether major Percentage of Name & address Sex &
nominee(S) the employees or minor or share to be of the person to percentage or
suffering from paid to each whom payment is person
legal disability to be made on mentioned in
or major state behalf of the column-5
his/her age minor or the
person suffering
from other legal
disability
1 2 3 4 5 6

Lubna Sohail
118 P Model Town Mother Major 100%
Extension Lahore

Dated: This 16th Days of May, 2022 at Mangla.

Designation: Sr.Clerk Signature of employee

Present Official 118 P Model Town Extension Lahore

Note – Nomination forms without the date

of birth of the employee will not be
Permanent 118 P Model Town Extension Lahore Entertained

Address

Two witness to signature of the member who must sign in the presence of other and in that of the member all being
present at the same time.

1. Signature _______________________
Address: _______________________
_______________________
Designation: ________________________

2. Signature _______________________
Address: _______________________
_______________________
Designation: ________________________
Drawing and Disbursing Officer