FORM ‘A’

GROUP LIFE INSURANCE

WAPDA EMPLOYEE
FORM OF NOMINATION
(When the Member has a family)
I, __________________________ born on ______________ s/o
_____________________________ hereby nominate the person (s) mentioned below, who
is a /are member (s)(of my family as defined in Rule 2 of the West Pakistan Water & Power
Development Authority Employees Provident Fund Rules, to receive in the event of my death
during service with West Pakistan Water & Power Development Authority, the amount that
may be admissible to my family under the Group Life Insurance Scheme of WAPDA
Employee in the manner shown against his / her / 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 a / are minor (s) is / are
suffering from legal disability.
Name & Address Relationship Whether Major Percentage of Name & Sex &
of the Nominee(s) with the or Minor or Share to be Address of the Parentage of
Employee Suffering from Paid to Each Person to Person
Legal Whom Mentioned at
Disability if Payment is to Column #
Minor State be Made on
His/Her Age Behalf of the
Minor or the
Person
Suffering from
Legal
Disability
1 2 3 4 5 6

Dated: This _________________ at _____________

Designation: Senior Engineer (Civil)
Present Official Address: __________________ Signature of the Employee
Permanent Address: ________________________
________________________
Note: - Nomination form without the Date of Birth of the employee will not be
entertained.
Two witness to signature of the member who must sign in the presence of each other
and in that of the member all being present at the time.
Signature of Witnesses
Signature: Signature:
Name: Name:
Address: Address:

Designation: Designation

Drawing and Disbursing Officer

 FORM ‘A’
NOMINATION FOR DEATH-CUM-RETIREMENT GRATUITY /
PENSION / PAY AND ALLOWANCES
(When the employee has a family and wishes to nominate one member thereof)
I, hereby nominate the person mentioned below, who is a member of my family and confer on
him / her the right to receive any Gratuity and the Pension that may be sanctioned by WAPDA
and arrears of my pay and allowances due to me, in the event of my death while in service
and the right to receive Gratuity, Pension and pay and allowances on my death which having
become admissible to me on retirement may remain unpaid at my death.
Name & Address Relationship Age Contingencies Name and
of the with the on the Relationship of
Nominee(s) Employee Happenings of the Person If Any
Which the to Whom the Right
Nomination Conferred on the
Shall Become Nominee Shall
Invalid Pass in the Event
of the Nominee
Pre-Deceasing the
Employee

Dated: This _________________ at _____________

Signature of the Employee

Signature of Witnesses
Signature: Signature:
Name: Name:
Address: Address:

Designation: Designation

To be filled in by the Head of Office in the case of subordinate employee

Nomination by Signature of Head Office

Designation: Designation:
Office: Date:

Caution: - This nomination can be cancelled at any time by sending a notice in writing
to the appropriate authority along with a fresh nomination.
 FORM ‘A’
SECOND SCHEDULE
RULE 32 (D)
FORM OF NOMINATION
(When Member has a family)
I, MUHAMMAD TALHA JAVAID hereby nominate the person (s) mentioned below,
who is a / are member (s) of my family as defined in Rule 2 of the West Pakistan Water
& Power Development Authority Employees Provident Fund Rules, to receive in the
event of my death, the amount that may stand to my credit in the manner shown against
his / her / their name (s).
I, hereby appoint the person (s) named in Column # 5 to receive payment on behalf
of nominee (s) who is a / are minor (s) is / are suffering from a legal disability.
Name & Address Relationship Whether Major Percentage of Name & Sex &
of the Nominee(s) with the or Minor or Share to be Address of the Parentage of
Employee Suffering from Paid to Each Person to Person
Legal Whom Mentioned at
Disability if Payment is to Column #
Minor State be Made on
His/Her Age Behalf of the
Minor or the
Person
Suffering from
Legal
Disability
1 2 3 4 5 6

Dated: This _________________ at _____________

Signature of the Employee

Signature of Witnesses
Signature: Signature:
Name: Name:
Address: Address:

Designation: Designation

Head of Division
Registered

BUDGET & ACCOUNTS OFFICER

(FUNDS)
This column should be filled in so as to cover the whole amount that may stand to the credit
of the member in the Fund at any time.