Form of Appointment of a Beneficiary for Death Benevolent Fund

To,

REL.GROUP SUP.SER.P.LTD

I, MR. PRABHJOT SINGH , the employee of REL.GROUP SUP.SER.P.LTD

hereby appoint following person/s beneficiary to whom the death benevolent fund
money payable under the scheme shall be paid in the event of my death.

SrNo. Name Relation Age %Share to each Nominee

1 SUKHWINDER KAUR MOTHER 46 Yrs 100.00%

Signed at .......................this Eighth day of November 2019 .

Signature of Employee
E.C.No.(10070475 )

Witnessed by :

Sign :

Name :

Address :