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 )
Saad Anwar Khan
Address
H#714, Street 27, Sector F Phase 8 Bahria Town Rawalpindi
CNIC
54400-9683070-3
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Arsalan Yasir
Address
H#312 J Block Sabzazar Lahore
CNIC
3320186265751
Relationship with the Member
Brother
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
2553
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature