This document contains an Employees' Provident Funds Scheme and Employees' Pension Scheme declaration and nomination form. It includes the member's personal details and nominations for provident fund accumulation and pension benefits. For provident fund, the member nominates their mother to receive 100% of accumulations. For pension benefits, the member nominates their mother, providing her name, address, date of birth and relationship. The member certifies having no other family eligible for pension benefits.