Jaye! Lal > Aescgl ol Lia Annex A ‘Goad byarbseaiinhe To letter dated 18 Oct, 2016 ‘Architects and Engineers gama 110 Natoraiy Memo Date of binh Sponsor 10 i not under SDC Sponsochip) To Admin & HR Dept fon Emp. Location: Date Subject Medical Insurance (2016 - 2017) This is to confirm that |, the undersigned, would like to insure the following members for Medical insurance 2016-2017: - 1. Confirmation of Employee & all Dependents in KSA Member Current | Requested (Employee / Name (As per igemaiiD) | Class Class | Date of Birth | Dependent Mobile # Cetegory | Category relationship with the omployee ) 2. Additional payment will be paid by me for myself & dependents i.e. employee, child & wife, if class of coverage is upgraded Regards, Signature