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 )
Ayesha javed
Address
officers colony , farid town, house# 176 block A, Sahiwal
CNIC
36502-2733312-0
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
75

02NOMINEE TWO

Full Name ( as per CNIC )
Ishrat noreen
Address
Basti Haji Rehmat Ali, Waahi Shah Suhammad, Rahim Yar Khan
CNIC
31303-9294520-0
Relationship with the Member
Sister
Percentage of Accumulation to be Paid
25
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
2598
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature