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 )
Amer ALI
Address
House # 147, Block C, Pak Arab housing Scheme, Lahore
CNIC
35201-0948337-1
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
70

02NOMINEE TWO

Full Name ( as per CNIC )
Muhammad haseeb
Address
House # 167, Block Q, Johar town , Lahore
CNIC
31104-7211802-1
Relationship with the Member
Brother
Percentage of Accumulation to be Paid
30
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
2446
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature