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 )
Khurram Saeed Butt
Address
House 76 Street 51 Sector C Phase 1 DHA Lahore
CNIC
3520227879065
Relationship with the Member
Father
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Ayesha Malik
Address
House 76, Street 51, Sector C Phase 1 DHA Lahore
CNIC
3520226311764
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
2589
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature