SII-AICLA Claims Technician Course Online Registration Form

1. Particulars of Applicant

(All fields are mandatory)

Name of Applicant:
Gender:
NRIC No.:
Applicant's academic qualification:
Applicant's employment Designation:
Address:
Office Tel No. :
Mobile No.:
Email Address:
Date of Course application:

2. Particulars of Sponsoring Organisation

(All fields are mandatory)

Name of Sponsoring Organisation:
Name of Authorised Person:
Address:
Contact No.:
Email Address:


3. Course Fees Payment

(All fields are mandatory)

Course fees payable: S$1,600.00 (No GST)
Cheque number and Bank:
Date:


I/We are pleased to enroll for the above course and confirmed that the information given above is correct.
I/We understand and consent that the acceptance of this application by me/my organization is subject to the Terms and Conditions set by The Singapore Insurance Institute.