Group Personal Accident Nomination

Employee Name : Sahith Kumar Organization Name : SNP CAPITAL IQ

Employee Number : 810841248
Pammaiahgari INDIA PVT LTD-HYDERABAD

Share Per
Sr. Relationsh Date of Bir Contact N
Nominee Name Email Id centage (i Address
No. ip To You th o.
n %)

HNO: 29-1306, Vi
26 Mar 199 707579579 nayak nagar, nere
1 Kavya Sri Wife choletikavya@gmail.com 50.00
9 5 dmet, Hyderabad,
500056

HNO 29-1306, Vin

06 Nov 197 939435076 ayak nagar, Nered
2 Ramesh Pommaiahgari Father 25.00
3 6 met, Hyderabad, 5
00056

HNO: 29-1306, Vi
13 Jan 197 901022557 nayak nagar, nere
3 Mamatha Pommaiahgari Mother 25.00
5 7 dmet, Hyderabad,
500056

I confirm that the information provided above is accurate to the best of my knowledge and can be used as the basis for distribution
of claims payout if any, in case the need arrises

____________
Date : 20 December 2022 11:09 PM Signature

Next Important Steps to Complete GPA Nomination

1) Sign on the Printed GPA Nomination Form.

2) Scan and Upload signed GPA Nomination Form by Clicking "Upload Form" button (File Format: jpg, jpeg, pdf)