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 )
Nadeem Ahmad
Address
house#2235/c, mohalla shipshah, near GMS#02, Dera Ismail Khan
CNIC
1210185056293
Relationship with the Member
Brother
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
NA
Address
NA
CNIC
NA
Relationship with the Member
NA
Percentage of Accumulation to be Paid
0
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
2579
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature