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 )
Syed Sherjeel
Address
House no 9E. Street no 16, G-6/2, Islamabad
CNIC
61101-8944521-8
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
100

02NOMINEE TWO

Full Name ( as per CNIC )
Khabir Kamran
Address
House no 21, street no 44, G-13/2
CNIC
61101-8944521-8
Relationship with the Member
Father
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
2669
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature