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 )
Umer Masood
Address
H#53, street 2, defence colony barafkhana chowk misrial road rawalpindi
CNIC
37405 5696055 7
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Syed Muhammad Mustshin Bukhari
Address
H#4, street 30, korang town, Islamabad
CNIC
37405 8749826 3
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
2481
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature