FAIR MEMBERSHIP APPLICATION FORM

Company Details
   
Name
Country
Tel
Fax
Email
Website
Postal Address
Working Days From To
Working Hours From To
   
Top Management
   
Name
Position
Tel
Mobile
Fax
Email
   
International Department
   
Name
Position
Tel
Mobile
Fax
Email
   
Establishment Date
   
Class of Business
Life Non-Life Composite Takaful
Company Capital (National Currency)
   
Authorized
Issued
Paid Up
Subscribed
   
Ownership
 
% National Entities/Individuals
% Others from Afro-Asian Countries
% Others from Non Afro-Asian Countries
 
Security Code