Enrolment Form

Workplace Savings and Retirement Plan

1. / Participant Details
a. / Employee Name
b. / Employer Name
c. / Employment Address / Unit No: Building:
Street:
P.O. Box: City: Emirate: Country: UAE
d. / Employee / ID No.
e. / Employment start date
f. / Position / Job Title
g. / Date of Birth / dd/mm/yyyy
h. / Gender / Male Female
i. / Marital Status / Single Married Others
j. / Emirates ID No.
k. / Personal Email
l. / Contact Number / Tel: Mobile:
m. / Correspondence Address / Unit No: / Building:
Street:
P.O. Box: City: Emirate: Country: UAE
2. Investment Details
My investment risk profile as identified through the mandotory Investment Risk Profile Questionnaire (please attach) is
Cautious Balanced Dynamic
My contributions into the Workplace Savings & Retirement Plan should be invested into the following:
Cautious Portfolio Balanced Portfolio Dynamic Portfolio Self Select
3. Primary Beneficiary Details
First Name / Last Name / Relationship / % Share
1
2
3
4
4. Secondary Beneficiary Details
First Name / Last Name / Relationship / % Share
1
2
3
4
5. Declaration

Select the box to confirm your participation in Workplace Savings and Retirement Plan
I hereby declare that the above information is true and accurate. I further agree that any information collected or held by the Company (whether contained in this Enrolment Form or obtained otherwise) may be used and/or disclosed by the Company to the trustees or whenever required by law.
I confirm that I have read and understood the details of the Plan from the Workplace Savings & Retirement Plan Employee hand book provided to me and I also understand the vesting schedule which gives me the right to access the Employers contribution made into this Workplace Savings & Retirement Plan.
I hereby authorize my Employer to deduct...... % of my basic salary (or) AED...... as my regular contribution to the Workplace Savings & Retirement plan.
Authorisation of payroll deduction for one time Additional Member Contribution
I hereby authorize my Employer to deduct AED...... as one time Additional Member Contribution
Select the box if you decline to participate in the Workplace Savings and Retirement Plan
I decline to participate in the proposed Workplace Savings & Retirement plan offered by my Employer. I understand that I shall not be entitled to any benefits or contributions associated with this plan. I may also not be allowed to participate in this plan at a later date.
Signature: Date:

Note: 1. Names should be filled in as appearing in Passport / Emirates ID

2. No decimals for contribution percentages

3. Refer to the employee handbook or check with your plan administrator for payment frequency of the plan

For Plan Administrator use only
Company Name
Plan No.
Initial Employee Contribution
Initial Employer matching Contribution
Total Initial Contribution
Name of the Authorized Signatory
Designation
Date

Authorized Signatory & Company Stamp

شركة عُمان للتأمين (ش.م.ع)، رأس المال المدفوع ١٢٥,٨٧٢,٤٦١ درهم إماراتي، رقم س. ت. ٤١٩٥٢، رقم القيد ٩ لدى هيئة التأمين بتاريخ ٢٤/١٢/١٩٨٤

المركز الرئيسي: ص.ب ٥٢٠٩، دبي، الإمارات العربية المتحدة. هاتف: ٧٧٧٧ ٢٣٣ ٤ ٩٧١+، فاكس: ٧٧٧٥ ٢٣٣ ٤ ٩٧١+، www.tameen.ae

Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984

Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae