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 )
Muhammad Attique Khan
Address
House no 57, Street no 41, Islampura Lahore
CNIC
3520224852047
Relationship with the Member
Father
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Shagufta Attique
Address
House no 57, Street no 41, Islampura Lahore
CNIC
3520223701344
Relationship with the Member
Mother
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
2697
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature