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 )
Mohsin Taj
Address
130/ A Burt Colony Garhi Shahu Lahore
CNIC
3520263110163
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
nil
Address
nil
CNIC
nil
Relationship with the Member
nil
Percentage of Accumulation to be Paid
0
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
2602
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature