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Benefts Nomination Form

Please read these notes before completing this form.

Completed form must submit to HR.

1 Employee Details :-

Name

IC No

Employee Number

Position

Department

Please complete the details for you nominated beneciaries, and select from the fol

indicate the beneciary!s current relationship to you.

2 Details o benefciaries

Name of beneciary Date of "ir

IC or Passport No

#ddress

Relationship to $e

3 Declaration

I ac%noledge this nomination cancels any and all pre&ious nominations I!&e gi&en.

I agree that I ha&e appropriate consent from the other indi&iduals I!&e named abo&e

details in this form.

Date

'ignature

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loing list to

th

 to gi&e their

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