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 )
Amina Shehzad
Address
House no 66, block L Gulberg 3 Lahore, Pakistan
CNIC
35202-2202756-2
Relationship with the Member
Mother
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Farrukh Rasool
Address
House no 3270, Tulip Block, new park view city, Multan Road, Lahore. Pakistan
CNIC
35202-6060831-9
Relationship with the Member
Husband
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
2706
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature