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 )
Muqqadas Malik
Address
House no 186 F/1 street 8 sector F Dha phase Lahore Pakistan
CNIC
3520193607986
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
80

02NOMINEE TWO

Full Name ( as per CNIC )
Aleezay Yousaf
Address
House 186f/1 street 8 sector F DHA phase 5 Lahore Pakistan
CNIC
3520212622272
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
20
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
2584
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature