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 )
Muhammad Ismail
Address
Bungalow # B-246, Mir Hussainabad, Indus Bungalows, Hyderabad
CNIC
4310224739053
Relationship with the Member
Father
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Tayyaba Abrp
Address
Flat # G-2, Ground Floor, Al-Madina Centre, Upper Gizri, D Street, DHA Phase V Karachi
CNIC
4130404067452
Relationship with the Member
Sister
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
2658
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature