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 )
Rubeena Kuasar Abbas
Address
House number 13, NIishtar Block, Allama Iqbal Town, Lahore
CNIC
3520224359064
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Muhammad Afnan Abbas
Address
House number 13, Nishtar Block, Allama Iqbal Town, Lahore
CNIC
3520213634287
Relationship with the Member
Brother
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
2676
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature