Benefits 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 beneficiaries, and select from the following list to
indicate the beneficiary's current relationship to you.
2 Details of beneficiaries
Name of beneficiary

Date of Birth

IC or Passport No

Address

Relationship to Me

3 Declaration
I acknowledge this nomination cancels any and all previous nominations I've given.

I agree that I have appropriate consent from the other individuals I've named above to give their
details in this form.
Date

Signature

e following list to

Birth

ove to give their