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 )
Nazia Bibi
Address
Tehsildar Colony Dhal Behzadi, P/O Saif Abad District and Tehsil Kohat
CNIC
14301-9772701-4
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Noor Rehman
Address
Tehsildar Colony Speen Jumat Dhal Behzadi Kohat
CNIC
21303-0432125-7
Relationship with the Member
Father
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
2476
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature