[PROVISIONAL TRANSLATION FROM PERSIAN]

[Translator’s notes appear in square brackets]

[Personal information has been redacted.]

28/5/1366 [19 August 1987]

In the Name of God, the Compassionate, the Merciful

The respected Office of Social Security, Shiraz

With greetings, I, Abbas-Ali Zareian-Jahromi, employee number [redacted] of the [National] Petroleum Company, was privileged to retire from the Pipelines and Communications section of [the company] in Shiraz on 15 Esfand 1359 [6 March 1981].  I request that you write down below this page that I do not receive any pensions or benefits from my retirement.

With great respect; wishing you success

[Signature] 28 Mordad 1366 [19 August 1987]