Middle East

H3ME-912-FM3H3ME-912-
Life Insurance Beneficiary Form FM3

Guidelines:
 This form is to be utilized to update or submit your Life insurance beneficiary details.
 Upon Completion form to be submitted to your local HR representative or emailed to HR.middleeast@aecom.com
 First, Middle & Last Name must be as per Passport.
 All dates must be entered as dd/mm/yyyy
 Allocation of benefits should total 100%.

SECTION I - Employee Details Existing Employee New Joiner

Oracle No. Date of Joining

First Name Last Name

Middle Name Marital Status Select

Country/Location Select Office/Site Location

SECTION II – Nominees for Group Life & Personal Accident Insurance

I hereby nominate the beneficiary/beneficiaries specified below to receive the sum payable under AECOM
Group Life & Personal Accident Insurance Scheme for Employees in the event of my death.

Name Relation Percentage Contact Details

Total 100%

Employee Name (type name) Signature Date

Life Insurance Beneficiary FormH3ME-912-FM3H3ME-912-FM3

Revision 0 March 31, 2016Form Page 1True1