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GLI Nomination Form PDF

The document is a nomination form for a group life insurance scheme managed by the ICAP Benevolent Fund. It allows the member to nominate beneficiaries to receive the claim amount in the event of their death. The form includes spaces to provide the nominee's name, relationship, date of birth, percentage of claim to be paid, and signatures of witnesses.

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807 views1 page

GLI Nomination Form PDF

The document is a nomination form for a group life insurance scheme managed by the ICAP Benevolent Fund. It allows the member to nominate beneficiaries to receive the claim amount in the event of their death. The form includes spaces to provide the nominee's name, relationship, date of birth, percentage of claim to be paid, and signatures of witnesses.

Uploaded by

xanax_1984
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The Institute of

Chartered Accountants HEAD OFFICE


of Pakistan
Benevolent Fund Dated :____________

NOMINATION UNDER GROUP LIFE INSURANCE SCHEME


(MANAGED BY ICAP BENEVOLENT FUND)

Being member of above referred group life insurance scheme, I hereby nominate the person or persons
hereinafter described in columns 1 of the following schedule to be the person or persons to whom the
amount of claim of aforesaid group life insurance scheme shall be payable in the event of my death in the
ratio of shares in column 4 in full discharge of ICAP liability.
THE SCHEDULE ABOVE REFERRED TO
Name, address and Relationship Nominee’s Percentage of claim Specimen Signature
N.I.C. No. of the with nominee date of birth to be paid to the of nominees (if adult)
nominee or or nominee(s) nominee / (s) for minor his / her
nominee(s) guardian
1 2 3 4 5

__________________________
Signature of Member (Insured)

Name of Member (Insured) _____________________


WITNESS:
ICAP Reg.# _________________________________
(i). Name _________________________________
Occupation__________________________________

Signature ___________________________________ Address: ___________________________________

CNIC # or ICAP Reg. # ________________________ ____________________________________________

(ii). Name _________________________________

Signature ___________________________________

CNIC # or ICAP Reg. # ________________________

Note: Please forward the form duly completed to:


Manager / Secretary – ICAP Benevolent Fund, ICAP, Chartered Accountants Avenue, Clifton, Karachi.

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