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Hill International, Inc.

Corporate Office
303 Lippincott Centre
Marlton, NJ 08053
Tel: www.hillintl.com

Employee Information Form - International

Please answer all questions completely even if the information is already on your resume

First Name PERVEZ AHMAD

Last Name KHAN

Date of Birth 09/07/1968

Name exactly as it appears on your Passport or National ID: KHAN PERVEZ AHMAD

Passport # Z 2066252 Passport Expiration Date 24/06/2021

County Issuing Passport Embassy of India, Riyadh,KSA

Security Clearance & Type ECNR

Section A - Spouse & Dependent Information

First Name Last Name Date of Birth Social Security Number

Spouse M F
SUFIA KHANUM 25/07/1978 K 1137645

Child M F ABDULLAH KHAN 16/08/2011 K 1138117

Child M F YASMEEN KHANAM 26/08/2009 H 9644617

Child M F AALIA KHANUM 13/03/2004 H 1580177

Child M F LAIBA KHANUM 07/10/2001 H 1580176

Child M F ELMA KHANUM 04/06/1999 G 8187434

Child M F

Marital Status:

Single Married Separated Divorced Widowed

 Hill International, Inc.
Corporate Office
303 Lippincott Centre
Marlton, NJ 08053
Tel: www.hillintl.com

Section B - Emergency Medical Information

This information is limited to authorized individuals only. It is maintained with the intent to assist in providing emergency medical assistance
in the event an employee becomes ill or is injured while in the workplace.

Please list emergency contacts you would like notified in the event of an emergency:

Primary Contact Secondary Contact Tertiary Contact

Name IMRAN KHAN SUFIA KHANUM SHAGUFTA KHANUM

Relationship BROTHER WIFE SISTER

Home Phone

Cell Phone 0091- 9897273792, 9760652534 0091- 9319860551 9897138079, 9897145417

Section C - Business Travel Accident Insurance Beneficiary Information

You are automatically enrolled in the plan on your first day of work. Your HR Representative will discuss the plan details with you at
Orientation
Please complete the Beneficiary information below to establish your participation in the program

Primary Beneficiary Contingent Beneficiary

Name SUFIA KHANUM Name IMRAN KHAN

Address H.No.: 4/63, Chhoti Masjid, Tooti Boundary, Jamalpur Address H.No.: 4/63, Chhoti Masjid, Tooti Boundary, Jamalpur

City ALIGARH State U.P Zip 202002 City ALIGARH State U.P Zip 202002

Relationship WIFE Relationship BROTHER

Please Email or Fax this completed form to your Regional Human Resources
Representative

Revision: 7/16/2009