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EMPLOYEE DEPENDENT INFORMATION FORM

 Information required in this form will be used to provide medical facilities to employees & their immediate family on subsidized charges from ULTH.
 Immediate family includes (Parents, Spouse & Children).

Employee details
SAP ID 00006175 Employee Mazhar Yasin Designation Lab Engineer
name
Department Technology Contact no. +923214839746 CNIC no. 35501-0394459-7
Dependent details
Relationship with
Dependent first Dependent Date of employee (Spouse,
Gender Nationality CNIC no. Occupation Contact number
name last name birth Father, Mother,
Son, Daughter)
Muhammad Yasin Male

For employee
I hereby declare that the above information is accurate and complete to the best of my knowledge. In case any of the above information is found incorrect I shall be liable and abide by the
University decision/action taken in this regard.

Signature _______________________________ Date ________________________


 Note: please attach CNIC/B-Form of dependent with this form

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