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 )
Rahat Basharat
Address
Flat no A1 - 204, Al Ghafoor Heaven. F.B area block 7
CNIC
4240118267560
Relationship with the Member
Wife
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Faraz Ahmed
Address
A 315 arshi heights fb area block 7
CNIC
4210157313957
Relationship with the Member
brother
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
2654
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature