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 )
Munawar Sufyan
Address
House 38, Block B , Guldasht Town, Zarrar Shaheed Road , Lahore Cantt
CNIC
35201-6935813-2
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
80

02NOMINEE TWO

Full Name ( as per CNIC )
Shafaq Sufyan
Address
House 38, Block B, Guldasht Town, Zarrar Shaheed Road, Lahore
CNIC
35201-0540373-6
Relationship with the Member
Sister
Percentage of Accumulation to be Paid
20
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
2660
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature