Delegate Registration Form

Please fill out the form below to register for the conference

NB:To ensure accurate and prompt processing of your payment confirmation, please be sure to include the following reference number in the subject line of your email:

Reference Number: # Check Accommodation : View

TITLE:

NAME:

SURNAME:

GENDER:

INSTITUTION:

POSITION:

E-MAIL:

TELEPHONE:

COUNTRY:

ORGANIZATION CURRENT STATUS:

HOTEL NAME:

HOTEL ROOM TYPE:

DATE OF ARRIVAL:

TIME OF ARRIVAL:

ARRIVAL AIRLINE/ FLIGHT NUMBER:

DATE OF DEPARTURE:

TIME OF DEPARTURE:

DEPARTURE AIRLINE/ FLIGHT NUMBER:

Excursion (Optional)

Would you like to go for the excursion?

FOREIGN PAYMENTS – (PAYMENTS FROM OUTSIDE GHANA)
Account Name: West African Insurance Companies Association
Account Number: 2441001140913
Swift Code: ECOCGHAC
Name of Bank: Ecobank Ghana
Bank Branch: Head Office
Address: 19 Seventh Avenue, Ridge West
P.O. Box AN 16746
Accra- North
Ghana

CITIBANK DETAILS – NIGERIA INSURERS ASSOCIATION
Bank: CITIBANK N.A
Bank Address: Canada Square, Canary Wharf, London, E14 5LB
Sort Code: 18-50-08
Swift Address: CITIGB2L
IBAN No.: GB80CITI8500810407941
Account No.: 10407941 (USD)
Account Name: Zenith Bank Plc
Zenith Swift Address: ZEIBNGLA
Beneficiary Name: Funds for further credit to Nigerian Insurers Association
Beneficiary Account Number: 5071241257

LOCAL PAYMENTS – (PAYMENTS WITHIN GHANA)
Account Name: West African Insurance Companies Association
Account Number: 3441001140914
Swift Code: ECOCGHAC
Name of Bank: Ecobank Ghana
Bank Branch: Head Office
Address: 19 Seventh Avenue, Ridge West
P.O. Box AN 16746
Accra- North
Ghana

For Nigeria Delegates Only
Bank Name: First Bank of Nigeria
Account Name: Nigerian Insurers Association
Account No.: 2000917791

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