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NAMLIFA Membership Application Form

1) The document is a membership application form for NAMLIFA, an insurance agent association. 2) It lists the annual membership fees for different membership types ranging from RM10 for a provisional membership to RM200 for a fellow membership. 3) The application form requests the applicant's personal details, company details, and preferred payment method for the membership fee which is non-refundable.

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seng kiong Lee
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244 views1 page

NAMLIFA Membership Application Form

1) The document is a membership application form for NAMLIFA, an insurance agent association. 2) It lists the annual membership fees for different membership types ranging from RM10 for a provisional membership to RM200 for a fellow membership. 3) The application form requests the applicant's personal details, company details, and preferred payment method for the membership fee which is non-refundable.

Uploaded by

seng kiong Lee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

NAMLIFA ANNUAL MEMBERSHIP FEE

MEMBERSHIP APPLICATION FORM PLEASE ATTACH


Provisional (once a lifetime) RM10
PHOTO FOR
Ordinary RM100
NEW APPLICATION NEW Affiliate RM100
APPLICATION Associate RM150
UPDATE INFORMATION Fellow RM200

PERSONAL DETAILS

Full Name (as in NRIC) :


(Please attach photostate IC)

New NRIC No : Old NRIC No :

NAMLIFA Membership No. Date of Birth :


(For existing members)

Sex : Male / Female Race : Malay / Chinese / Indian / Others

Correspondence Address :
Postcode :

Tel : (o) (H) (H/P) (Fax)

Email :

Highest Qualification Attained : SPM STPM/COLLEGE Tertiary &Above

COMPANY DETAILS

Date Contracted as Agent : Agent’s Code :

Position : Agent ASM USM GSM AM Full Time Part Time

Company : Convential Takaful


Agency :

PAYMENT
A. Cash / Cheque Payment
Enclose Payment RM by Cash / Cheque No. : (payable to NAMLIFA)
(NAMLIFA Account: Hong Leong : 2810 0000 380, kindly provide bank in slip)

B. Credit Card Payment One Time Deduction Auto Renewal


Please charge to my credit card (I hereby authorise NAMLIFA to debit my credit card/ Debit Card account) Visa Master

Credit Card No. : Issuing Bank :

Cardholder’s Name: Expiry Date : /


Cardholder’s Signature:

C. Company Deduction ( Auto Deduction/Renewal) [Except: AIA, AXA Affin, Manulife, Prudential & Takaful Agents).
I, declare all the above information is correct at the time of application and I hereby authorise
(Company) to debit RM , payable to
NAMLIFA from my commission as per my Agent Code or Account No : , on an Annual Basic,
I understand that membership fees paid are non-refundable.

Signature : X Date:

TERMS AND CONDITIONS


Registration of membership will only be processed upon the following:- Membership fees paid are non - refundable.
- successful clearance of cheques.
- successful swiping of credit cards. In the event of lost of membership card, a replacement fee of RM20/= will be
- successful clearance of company deduction. charged for processing of a new card.

For company deduction, kindly allow 30 - 40 days of processing time I agree that my signing on the NAMLIFA membership form shall constitute my
before delivery of membership card. acceptance of and my agreement to be bound by the terms and conditions
- Membership cards will be delivered within one month from the date of contained in this form.
successful registration of membership.
Signature : X

FOR OFFICE USE ONLY


Date Received : Membership No : Approved / Rejected
Remark : Processed By :

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