African Insurance Exchange

Fill your details below REGISTRATION FORM

PERSONAL DETAILS

First Name *:

Surname *:

Email *:

Gender *:

Race *: (required for reporting purposes)

Age group *:

Country *:

ID/Passport Number *

Industry Category *:

Job Title *:

Cellphone *:

Do you require a Letter of Invitation for visa purposes? *

Select a Membership Type to Continue *

Corporate Partner

Individual Member

Non-members

TYPE OF EVENTS

Live at Sun City

Virtual- Online

Fee (excl. VAT)

ACCOMMODATION

I'll organize my own:

Tick here if you do not want to book accommodation with us.

Please select your preferred accommodation below. Accommodation can only be booked here for the full conference period - checking in Sunday, 23 July 2023 and checking out Wednesday, 26 July 2023. For different periods, other requirements and different room types/hotels, please email the address at the bottom of the page after booking

Are you sharing a room with someone else?

If YES, Who is sharing your room?

Name and surname:

ID:

Accommodation:

Arrival date:

Departure date:

INVOICING

Payment is due 14 days after registration (outstanding registrations will be deleted)

Bank Details

Bank:

First National Bank

Account Name:

Insurance Institute of South Africa

Account Number:

62113428793

Branch Code:

255805

Payment Reference:

Registration Reference

Swift Code:

FIRNZAJJ

Address Invoice to Street Address/Post Box

City:

Postal Code:

Province:

Country:

Company/Organisation:

Contact Name:

VAT Number :

E-mail Invoice To:

Purchase Order Number:

IISA Membership Number: (for IISA reporting purposes)

EXCL VAT:

R 00.00

VAT:

R 00.00

Total Cost:

R 00.00

General Data Protection Regulation

General Data Protection Regulation & POPIA

All information is stored on our server and is handled as per our Policy Statement. We do not store credit card details or do any financial transactions on our server.

Have you read and understood the GDPR, POPIA & Refund Policy?
I understand *