APPENDIX()

FORM OF APPOINTMENT OF
BENEFICIARY(NOMINATION

TheTrustees,
DowChemicallnternationalPrivateLimitedE
mployee'sGroupGratuityScheme
DearSirs
SRAVAN KUMAR VEMUGANTI aMember of the
Dow Chemical International Private Limited Employee's Group Gratuity Scheme
herebyagree to abide by the Rules of the said Scheme and do also hereby appointin terms ot
Rule-18 of the Rules the Beneficiary/ies Nominee/s mentioned hereunder to receive the
benefits.payable under the Scheme, in the event of my death before the amount becomes
payable hasnotbeen paid.

I hereby
direct that the benefits under the Scheme, payable in respect of me, shall be
paid
tothe said Beneficiary/ies Nominee/s in proportion indicated against their respective names
asgivenbelow:

Sr.No.NameinFullwithf Relationship AgeofNominee/s Proportion

ull address withthe Beneficiary/ies
ofNominee/ Member
by
whichgratuity
sBeneficiary/ies (Employee) (TotalBenefits)will
besharedbyeachNo
minee/Beneficiary)
HINDU TADAKAMALLA |SPOUSE 29 YEARS 100%
LIG 331. MADHUBAN
COLONY. KATTEDAN.
|HYDERABAD, 500077

2.

3.
Iherebycertifythatthe person(s) mentionedherein above
is/aremywife/children/lawfullyadoptedchild/dependent parents/husband.

Iherebydeclarethatlhaveno familyand shouldlacquiresfamilyhereafter

theappointmentofBeneficiary/Nomineeshould bedeemed ascancelled.

not dependent on me.

MyFather/Mother/Parents/Sister(s)/minorbrother(s) isaree

Myhusband's father/parentsis/arenotdependent on me.

lalsodeclarethatthis appointmentofBeneficiary/ies/Nominee/s
madehereinshallhavetheeffectof myrevokingthe appointment ofBeneficiary/ies /Nominee/s

Igivebelowtheparticularsaboutmyself.

. FullName: SRAVAN KUMAR VEMUGANTI

MALE
2. Sex:
HINDU
3. Religion:
SRINIVASA RAO VEMUGANTI
4. Father'sName:
5. Husband'sName:
(Formarriedwomenonly)
MARRIED
6.MaritalStatus:
(Whethermarried,unmarried,widoworwidower)
7.DateofBirth: 23-AUG-1987
LIG 331, MADHUBAN COLONY, KATTEDAN, HYDERABAD, TELANGANA, INDIA
8.PermanentAddress:
PIN 500077

General Business
Signedat HYDERABAD this24 _dayof DECEMBER 2021

SignatureoMember/Employee

TwowitnesstotheSignature.

Name Address Signature

1. TVenU LonelRao flAwo 1OG,mAelaymi

Keysdouq Nalaanda
2.5shnvas Rao V 31,Aadhub n Coq

Certified that the above appointment of Beneficiary/Nominee has been signed

byShri/Shrimati_
Before me after he/she has read the entries, the entries have been read to him/her by mne
andthatthe saidappointmentofBeneficiary/Nomineeis recordedunder theScheme on

Signature of
Trustee/sForSelfandCo
Trusteesof
Dow Chemical International Private

Place:

Date:

General Business
NOTE

WhereanEmployeeMemberhasafamilyatthetimeofappointingaBeneficiary/Nomince,

of hisfamily orlly. Any

the Nomination should be made in favour of Members
belongingto
such Employee in favour of any
other personsnot
Nomination made by
his familyshall be invalid.

at
made by Member may be changed
An Appointment of Beneficiary/Nominee
2. intention to do so. I
notice to the trustees of his
anytime, after giving a written
ofthe Nominee
the interest
theNominee predeceases the Member (Employee),.
shallrevertto theMembers (Employee) orhis estate

time
thereof made from
or any change
3. The appointment of Beneficiary/Nominee which it is received by
effect to the extent it is valid on the date in
totime shall take

theTrustees.

means Member's (Employee's)

For the purpose of the Scheme, "Family"
4. and minor brothers dependent
spouse,legitimate children/step
children, parents, sisters

uponhim.

General Business