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 )
Kalsoom Akhtar
Address
New Nasheman Colony Labar Block Multan
CNIC
3630203302512
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
60

02NOMINEE TWO

Full Name ( as per CNIC )
Nimra Malik
Address
New Nasheman Colony Labar Block Multan
CNIC
3630257573022
Relationship with the Member
Sister
Percentage of Accumulation to be Paid
40
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
2577
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature