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 & Relationship Whether Major Percentage of Name & Address of Sex and
Address of the with the or Minor or Share to be the Person to Whom Parentage of
Nominee(s) Employee Suffering From Paid to Each Payment is to be Person
Legal Disability Made on Behalf of Mentioned at
if Minor State the Minor or the Column # 5
His/ Her Age Person Suffering
From Legal
Disability
1 2 3 4 5 6

Dated: This ____________day of __________________ at_____________________________

Designation: ________________________
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

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 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 and Relationship Age Contingencies Name and Relationship

Address of the With the on the of the Person If Any to
Nominee Employee Happening of Whom the Right
Which the Conferred on the
Nomination Nominee Shall Pass in
Shall Become the Event of the Nominee
Invalid Pre-Deceasing the
Employee

Dated: This ________________day of _____________________ 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 of 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.

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 FORM ‘A’
SECOND SCHEDULE
RULE 32 (D)
FORM OF NOMINATION
(When the Member has a family)

I, _________________________ 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 and Relationship Whether Major or Amount or Name & Address Sex and
Address of the With the Minor or Share of of the Person to Parentage of
Nominee(s) Employee Suffering From Accumulations Whom Payment is Person
Legal Disability. to be Paid to to be Made on Mentioned at
If Minor State His Each Behalf of the Minor Column # 5
/ Her Age or the Person
Suffering From
Legal Disability
1 2 3 4 5 6

Dated: This ____________day of ________________________ at_______________________

Signature of the Employee

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 same time.

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.

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