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 )
Seemab Tahir
Address
Crown Street Asghar Ali Raod Near Police Station Civil Lines, Gujranwala
CNIC
3410402184772
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Nill
Address
Nill
CNIC
Nill
Relationship with the Member
Nill
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
2642
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature