ACISP - Africa College of Insurance and Social Protection

AFRICA COLLEGE OF INSURANCE AND SOCIAL PROTECTION
(ACISP)

"The Bridge between Industry and Academia"

Registration No: REG/BTP/233P

Thank you for choosing to attend the International Certificate in Inclusive Insurance - Cohort 2. ACISP wants to make the process as easy as possible.

You will need to complete a separate registration form for each individual attending.

Title :

Prof.

Dr.

Mr.

Mrs.

Ms.

Miss.

Gender :

Male

Female

Surname

First name(s)

Training Title

Start Date

End Date

Country of Residence

Physical Address

Highest Level of Education

Designation

Mobile :

Who will be responsible for Payment?

Employer

Employer and Self

Self

Company Name

Special dietary requirements:

None

Vegetarian

Halaal

Diabetic

Other

FEE STRUCTURE

NOTE: Participation Fee per person is TZS 1,355,000/= per Module.

Description	Mode	Fee(TZS)
Fee Per Person (For all 4 Modules)	Physical	TZS 5,420,000/=
Fee Per Person (For all 4 Modules)	Online	TZS 2,1700,000/=

Participation Fees should be deposited to:

A/c Name – AFRICA COLLEGE OF INSURANCE AND SOCIAL PROTECTION LTD
A/c No: 0250481024400(USD)
A/c No: 0150481024400(Tshs) at any CRDB branch.

All cheques should be addressed to : Africa College of Insurance and Social Protection Ltd.
Submit the original pay-in slip to ACISP Training Facility at Masaki-Oysterbay, 386 Toure Drive, No.99.

APPLICATION FORM

FEE STRUCTURE

NOTE: Participation Fee per person is TZS 1,355,000/= per Module.

Participation Fees should be deposited to: