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 )
Sheher Bano
Address
House No 146, Street No 4 Rehmat Colony Mustafabad Dharampura Lahore
CNIC
3520164177192
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Dilawar Hussain
Address
House No 146, Street No 4 Rehmat Colony Mustafabad Dharampura Lahore
CNIC
3520168380183
Relationship with the Member
Brother
Percentage of Accumulation to be Paid
50
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
2650
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature