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 )
Gulfreen Bibi
Address
House R 381, Salahuddin Street , Nafees Chowk Attock City
CNIC
37101-1721590-4
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Maria Sajid
Address
House R 381, Salahuddin Street , Nafees Chowk Attock City
CNIC
36302-4200083-2
Relationship with the Member
Sister
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
2592
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature