LIFE
INSURANCENOMINATION FORM

Employee Declaration

I hereby direct that the amount payable to me from the Confiz Group Life Insurance Policy, at the time of my death (Nature or Accidental) shall be distributed among the person(s) mentioned below in the manner shown against their names:

01NOMINEE ONE

Full Name ( as per CNIC )
Bakhsha Ram
Address
K.Shoes, Shop#12, Sir sadiq markeet sadiqbad, RYk
CNIC
3130426603463
Relationship with the Member
BROTHER
Percentage of Accumulation to be Paid
10

02NOMINEE TWO

Full Name ( as per CNIC )
Bakhsha Ram
Address
K.Shoes, Shop#12, Sir sadiq markeet sadiqbad, RYk
CNIC
3130426603463
Relationship with the Member
BROTHER
Percentage of Accumulation to be Paid
10
Witness 1 | Full Name
CNIC
Witness 1 Signautre
Signature
Witness 2 | Full Name
CNIC
Witness 2 Signautre
Signature

Yours Faithfully,

Employee's Name
Employee ID
2063
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature