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 )
Malaika Naseer
Address
House # 20 Chohan Road, Islampura, Lahore
CNIC
3520218833144
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Mirza Ghulam Ali
Address
House # 20 Chohan Road, Islampura, Lahore
CNIC
3520236322959
Relationship with the Member
Son
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
2652
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature