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 )
Yusra Arif
Address
flat# B-305, 3rd Floor, Ajmer Garden , gulshan e Maymar , Karachi, sindh
CNIC
4530484477048
Relationship with the Member
Husband
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Wazir Ali Alias Muhammad Murad
Address
flat# B-305, 3rd Floor, Ajmer Garden , gulshan e Maymar , Karachi, sindh
CNIC
4320345034971
Relationship with the Member
Son
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
2682
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature