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 )
Farhat Mehmood
Address
Muhallah Chorkey Shadiwal Tehsil and Distt. Gujrat
CNIC
34201-2529181-5
Relationship with the Member
Brother
Percentage of Accumulation to be Paid
30

02NOMINEE TWO

Full Name ( as per CNIC )
Shamim Mahmood
Address
Muhallah Chorkey Shadiwal Tehsil and Distt. Gujrat
CNIC
34201-04303702
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
70
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
2645
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature