[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


In the Name of God

Order to amend or increase retirement or disability pension

The Government of the Islamic Republic of Iran

Form A-57 (36-1), Administrative and Recruitment Affairs Organization of Iran


1- Ministry: Roads and Transportation

2- Employee Number: [redacted]

3- Retirement Number: [redacted]

4- Employee’s Particulars:

Name: Mr. Habibollah

Surname: Sajedolhagh

Father’s name: Mohammad

Date of birth: 22 Farvardin [redacted] [11 April [redacted]]

Birth certificate number: [redacted]

Birth certificate place of issue: City [redacted], Province [redacted]

Gender: Male

5- Employee’s status: Retired

6- Date of retirement or disability: 1 Ordibehesht 1354 [21 April 1975]

7- Employee’s employment status: Under Employment Act, ratified 31 Khordad 1345 (2525) [21 June 1966]

8- Details of order: By virtue of this order, as of 2 Mehr 1359 [24 September 1980], your retirement pension is terminated.

9- Date and number of final order:

Date: 31Ordibehesht 1358 [21 May 1979]

Number: 6748

10- Retirement or disability pension set in final order: ---- rial

11- Current retirement or disability pension: ---- rial

12- Increase: ---- rial

13- Pension deduction arrears: ----

14- Retirement or disability pension, subsequent to determination of deductions required, is payable from ----.

15- Order enforcement date: Day 12 Mehr 1359 [4 October 1980]

16- Date of issue and Order number: Date: 2 Mehr 1359 [24 September 1980], Number: 23400

17- Name and surname of officer: -----

Title and position: On behalf of the Minister for Roads and Transport: Copy: Employee

Signature: [signature]


[Handwritten notes at the top of the page]