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 )
Sidra Ishtiaq
Address
Bahria Town, Lahore
CNIC
3840312043042
Relationship with the Member
Spouse
Percentage of Accumulation to be Paid
90

02NOMINEE TWO

Full Name ( as per CNIC )
Zaira Fatima
Address
Bahria Town Lahore
CNIC
3520141554588
Relationship with the Member
Daughter
Percentage of Accumulation to be Paid
10
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
2627
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature