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 )
Qasim Iqbal Butt
Address
H.no. 260, A/2-B, Ahatta Makhan Singh Old Dharampura
CNIC
3520113181175
Relationship with the Member
Father
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Rubina Qasim Butt
Address
H.no. 260, A/2-B, Ahatta Makhan Singh Old Dharampura
CNIC
3520112611972
Relationship with the Member
Mother
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
2667
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature