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 )
Huma Nisar
Address
256/7, Block-B, Punjab Co-Operative Housing Society, Lahore
CNIC
6110188885613
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
90

02NOMINEE TWO

Full Name ( as per CNIC )
Afshan Umer
Address
707C, Alpine Plaza, Block-10, Gulistan-e-Jauhar, Karachi
CNIC
6110188885613
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
10
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
2560
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature