Registration Form for the Group Life Insurance Protection with Accident or Critical Illness Rider

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How to register
Interested members are to supply their data by completing this form and pay the annual premium stated in their age category to the Institute’s GTBank Account No. 0006819203.

Further clarification contact:
Margaret Moore, FCIIN, FNIMN
(08055999103/ megatrustinsurancebrokers@gmail.com

Mega Trust Insurance Brokers Limited.
No. 36, Orlando Martins Street, off Igbosere Road, Lagos Island, Lagos.

Your NIMN Membership Grade *

Fellow

Full member

Associate member

Graduate member

Student member

Full Name (Surname first) *

Gender *

Male

Female

Date of birth *

GSM Number *

Email Address *

Sum Assured/Premium *

N7,000

N9,000

N15,000

Customised package

Beneficiary's full name (Wife, husband, son or daughter) *

Submit

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