Diploma in Insurance Registration & Examination Entry Form icon

Diploma in Insurance Registration & Examination Entry Form


INSURANCE TRAINING AND EDUCATION TRUST

Kenya National Insurance Examinations Board

P.O. BOX 56928-00200 NAIROBI, TEL: 6009175, 605601-4, FAX: 6005605

E-Mail: info@knieb.co.ke

Off Nairobi-Mombasa Road, Belle-Veu exit at South “C” Nairobi.

Diploma in Insurance Registration & Examination Entry Form




NOTES


  1. Complete the application form in capital letters (In black or blue ink)

  2. Enclose a photocopy of your Identity Card (both sides), or Passport (first 3 pages), and a copy of KCSE certificate with a minimum of C Plain (C) or its equivalent for those sitting for the first time.

  3. Incomplete forms will be returned to the applicant

  4. Note to indicate the Postal Code.


Personal details




Please give your registration number if known Reg.




Mr/Mrs/Miss/Ms Surname





Other Names

date month y ear

Nationality Date of Birth





Mobile No. Gender Male Female





Contact P.O. Box Postal Code

Address





Town





Email





Identity Card No/

Passport No.


Examination details



1. Have you ever sat for the Diploma examination? Yes No


2. If Yes, list the subjects you have been credited (Codes only)



(Progression rule will strictly apply)



3. I wish to enter for the Diploma Examination to be held in: (tick as appropriate) May 2012 November 2012

4. Preferred Centre (Tick one)



Nairobi Mombasa


5. Method of Study (Tick one)





Full time College Part time College Private

6. I wish to enter for the following subjects (Tick appropriately)



CORE


CC1 CC2 CC3A CC3B CC4 CC5A CC5B



TECHNICAL

TC1 TC2

SPECIALIST

^ GENERAL LIFE PENSIONS




GI-1 LA-1 PS-1




GI-2 LA-3 PS-2






GI-3 LA-4 PS-3




GI-4 PS-4



FELLOWSHIP

OM1 OM2 OM3 OM4 OT1 OT2 OT3 OT4 OT5


Fees and payments




Registration fees (Annual fee)




Examination fees




Late entry fees (50% of exam fees)



Total Fees


Paid by (tick one): Self Company Name of the Company




Mode of Payment


Exam fees can be deposited in the account below or a Bankers cheque drawn in favour of the account below:


Account Name: ^ Kenya National Insurance Examinations Board Bank & Branch: KCB - Kipande House

Account Number: 1103954652


Declaration by the Applicant


I hereby certify that all statements on this application form and any material filed in support hereof are true, correct and complete and all required information has been disclosed.


Signature of applicant: Date:


FOR OFFICIAL USE ONLY


Form checked by:


_______________________________________ Date ___________________________________


Cashier ___________________________ Date ___________________________________


Total Fees paid: Kshs.____________________ Receipt No. ________________________________


An interim establishment of the Insurance Training & Education Trust






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