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 )
Aiman Nazir
Address
House 12 Street 7 Sector C DHA Phase 2 Islamabad
CNIC
3310083437564
Relationship with the Member
Spouse
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Noor-e-Adan
Address
House 12 Street 7 Sector C DHA Phase 2 Islamabad
CNIC
6110186334152
Relationship with the Member
Daughter
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
2583
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature