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 )
Adnan Rafique Ghumman
Address
218/E Walayat Manzil, Saidpur, Main multan road opposite pillar # 168 of Orange metro train line, Lahore
CNIC
35202-2624221-3
Relationship with the Member
Father
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Shabnum Saeed
Address
218/E Walayat Manzil, Saidpur, Main multan road opposite pillar # 168 of Orange metro train line, Lahore
CNIC
35202-2538104-8
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50
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
2436
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature