INSURANCE INSTITUTE OF INDIA

ONLINE EXAMINATION FOR GENERAL INSURANCE AND LIFE

INSURANCE (IGIE Foundation Programme administered by
AICPCU/IIA)

Passport Size
Registration Form (IGIE Exam) Color
Exam Centre: - MUMBAI Photograph Duly
Signed

Institute for Global Insurance Education

Select Branch : - (Tick Which Ever is applicable)

1) Life Branch [951- Life Insurance Basics]

2) General Branch [950- Introduction to Global Risk Management, Insurance, and Financial Services]
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First Name: - ___________________ e Name: - _______________________
Last
D D M M Y Y Y gY
Date of Birth:-
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Educational Qualification s
: - ____________________________________________

Employer Name
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: - ____________________________________________
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Professional Qualification : - ____________________________________________
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Work Experience : - ____________________________________________
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Address i
: - ____________________________________________

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City: - ______________ Country: - _______________ Pin:-
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Street: - _________________________________________

Telephone (Office) STD Code F Tel: - __________________

: - _______

Telephone (Residence) STD Code o Tel:- __________________

: - _______
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Mobile Number: _________________________

Email Id
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: - _____________________________________________

Demand Draft Details : - _____________________________________________

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Place: - ________________ I
Date: - ________________ Signature of the Candidate
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