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 )
Tahir Iqbal
Address
house 108, street 3, Block T, DHA Phase 2, Lahore
CNIC
6110190664019
Relationship with the Member
Father
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Fouzia Tahir
Address
house 108, street 3, Block T, DHA Phase 2, Lahore
CNIC
6110123970910
Relationship with the Member
Mother
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
2576
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature