Name of company or individual (If you are nominating your own company or yourself):
Company / Your Name
Title
Address
Tel
Fax
Email
If nominating another company or individual:
Company / Your name
Title
Address
Tel
Fax
Email
Award/s entered (please tick box)
General Insurance Company of the Year
Life Insurance Company of the Year
Educational Service Provider of the Year
Innovation of the Year
Service Provider of the Year
Risk Manager of the Year
Broker of the Year
Loss Adjuster of the Year
Reinsurance Broker of the Year
General Reinsurer of the Year
Life Reinsurer of the Year
Insurance/Reinsurance Industry Contribution Award
Corporate Social Responsibility Award
Personality of the Year Award
Please attach your supporting documents
Nominated by (Optional)
Name
Tel
Fax
Email