The Insurance Institute of Zambia (IIZA)

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Membership Application / Amendment Form

Email *

GENDER

Male

FEMALE

TITLE

SURNAME

OTHER NAMES

NRC NUMBER *

DATE_OF_BIRTH *

RESIDENTIAL ADDRESS

WORK ADDRESS

TOWN

COMPANY

EMPLOYER ADDRESS

CONTACT PHONE

OCCUPATION AND POSITION

CONTACT E-MAIL ADDRESS

YEARS OF SERVICE

MEMBER CATEGORY

FELLOW (if hold ACII) ZMW 1,000 MEMBERSHIP FEE

ASSOCIATE(if hold a Professional Diploma) ZMW 750 MEMBERSHIP FEE

ORDINARY (Degree or just working in the insurance industry)ZMW 500 MEMBERSHIP FEE

STUDENT (if not working but pursuing insurance studies) ZMW 100 MEMBERSHIP FEE

IIZA BANK DETAILS:

NAME: INSURANCE INSTITUTE OF ZAMBIA

REGISTRATION NO.: ORS/102/27/810

BANK NAME: ZANACO

BRANCH: NORTHMEAD

ACCOUNT NO.: 1327403500164

SORT CODE: 010075

SWIFT CODE: ZNCOZMLU

(Send electronic copy of Proof of Payment(POP) to justine@iiza.org or WhatsApp: 0977672302) together with completed Membership Form and CV.

QUALIFICATIONS HELD (Tick all applicable)

FELLOW

ADVANCED DIPLOMA/ASSOCIATE

DIPLOMA

CERTIFICATE

DEGREE

MASTERS

DOCTORATE

DATE ENTERED

ENTERED BY

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