2 FORM: PE -01 : (Revised) EMPLOYEES’ OLD-AGE BENEFITS ees INSTITUTION APPLICATION FOR EMPLOYEE'S REGISTRATION $V ca nny ypc? 1. Name (in block letters) as shown jn the National identiy Card. basin SN NAsitaat Sex fe Wet Fathers / Husband's Name (Pho aa Date of Birth National identity Card No. (Please enclose photocopy of both sides) s ce “LESS LisiiFest 5.A Nadra National Identity Card No. : * 5B Family Code [ 1 s (wore 6. Present Address: auer Permenant Address, * Certificate of Employer etait Worker's Signature / SMFS 7. Employment of te above employee began on Bienes 8. Date of applicabiity of the scheme Enis 9. National ldentty Card checked and details shown on ths form are certified correct. i are WS REL IAS ENFESUE MSA 10. of establishment, Nene ishment Worker's Thumb impression’ ose Registration No. = ‘Sub ode if any . ‘nshbs ee Singnature of Employers zt Cake thew Name———__—______ be Designation FOR OFFICE USE ONLY Lepr EOBI Registration Card No. = = i AARHBASI48) 1-03 issuedinot issued