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

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

Your NIMN Membership Grade *
Full Name (Surname first) *
Gender *
Date of birth *
GSM Number *
Email Address *
Sum Assured/Premium *
Beneficiary's full name (Wife, husband, son or daughter) *
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