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 )
Kh. Maqbool Mehmood Lone
Address
House #144 - Street 1 - DHA Phase 4 - Lahore
CNIC
35202-2279530-5
Relationship with the Member
Daughter
Percentage of Accumulation to be Paid
40

02NOMINEE TWO

Full Name ( as per CNIC )
Tanweer Amin
Address
House # 48 - Block D2 - Johar Town - Lahore
CNIC
352005-804522
Relationship with the Member
Cousin
Percentage of Accumulation to be Paid
60
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
2600
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature