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 )
Nashra Khalid
Address
House 854 Street 74 Hill View Block Pakistan Town Islamabad
CNIC
904001-6171565-0
Relationship with the Member
Spouse
Percentage of Accumulation to be Paid
75

02NOMINEE TWO

Full Name ( as per CNIC )
Chaudhry Adil Rafique
Address
House 854 Street 74 Hill View Block Pakistan Town Islamabad
CNIC
42201-5434712-9
Relationship with the Member
Father
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
2624
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature