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 )
Rubina Bashir Mirza
Address
W5-C, Asakri-1, Cantt Lahore Pakistan
CNIC
320052484004
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Zenith Irfan
Address
W5-C, Asakri-1, Cantt Lahore Pakistan
CNIC
352021340652
Relationship with the Member
Sister
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
2665
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature