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Membership Application Form

Please fill out the following registration form and click Submit when you are finished. All information will be e-mailed to the AIO secretariat and we will respond to you as soon as possible.

Name of Company/Organisation:
Address:
Phone:
Fax:
Email:
Legal Status (please check one):

a) Insurance or Reinsurance Company
b) Insurance or Reinsurance Broker, or Auxiliary Services
c) Insurance Control or Supervisory Authority
d) National or Regional Association of Insurers and Reinsurers
e) Insurance education/training Institution

For a and b above, please show % of ownership by African Nationals
Percentage of ownership:  
Name of person authorizing membership:
Title/Designation:
Date: