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  Paybill No: 830300 
 
 Online User Profile Ref. -  
1.  Registration Details  * from registrar of companies for new applicants  Fill all details. Fields marked with * are mandatory before saving this form. 
Registered Name:  * Ownership Type:  *
Business Type:  * Certificate of Registration:  
2.  Contact Details
Main Office: *  Physical Location:  
P.O. Box Number: *   * must be numeric Telephone Number (s):  
Town / Postal Code: *  Mobile Number (s):  *
Branches At:   Email Address:   * 
3.  Principal Officer Details
Principal Full Names * Nationality * ID or Passport No. *
Year of Birth Academic Qualifications Professional Qualifications (attach Certificate)   Insurance Experience


 
4.  Ownership Details   ( Individual, Partners or Shareholders)  -- Click 'Save to Add >> ' button to save the individual, partner or shareholder details.
Full Names * Nationality  ID or Passport No. * Soft Copy of ID or Passport No.  Delete
  
  * You will be redirected to the login page if it is your first time.
 
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