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 )
Syeda Shaheera Bukhari
Address
Askari 11 Islamabad
CNIC
3740563511710
Relationship with the Member
Spouse
Percentage of Accumulation to be Paid
50

02NOMINEE TWO

Full Name ( as per CNIC )
Nabaa Omar
Address
E11 Islamabad
CNIC
3740560573910
Relationship with the Member
Sister
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
2707
Employee Signautre
Employee Signature
HR Authorized Signautre
HR Authorized Signature