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 )
Erum Aziz
Address
House no#179 Talib-ul-mola colony block 11 1/2 orangi town karachi
CNIC
4240197580790
Relationship with the Member
Spouse
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Mushk Adnan
Address
House no#179 Talib-ul-mola colony block 11 1/2 orangi town karachi
CNIC
-
Relationship with the Member
Child
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
2524
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature