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 )
Haider Ali
Address
Qamar Saylavi Road, Near Gujrat Model School, Gulberg Colony, Gujrat
CNIC
34201-1966336-7
Relationship with the Member
Brother
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Sajida Jamil
Address
Qamar Saylavi Road, Near Gujrat Model School, Gulberg Colony, Gujrat
CNIC
34201-0378264-4
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
100
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
2641
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature