Upload Photo *
Click here to upload
Your recent photograph image must be
- in colour taken against plain white background without shadows;
- show the full face;
- in business attire;
Your photograph image attachment file must be
- JPEG format ('jpg' extension)
- file size should be about 150 Kbytes;
- dimension of the photo image has to be 400 by 514 pixels;
Preferred Name on badge
Year of Birth
Select One 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Highest Educational Level
GCE 'N' Level
GCE 'O' Level
GCE 'A' Level
Diploma from Public Polytechnic
Diploma from Private Education Institutions (PEIs)
Others (Please specify below)
Name of Company
Select One Life Insurer General Insurer Composite Insurer Reinsurer Takaful Insurer Others
Others (Please specify below)
Job Title / Designation
Years of Management Experience
Select One 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
* Select One Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France, metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay US Minor Outlying Islands Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Secretary's E-mail (if any)
Special Dietary Requirements:
No Pork, No Lard Meal
Contact Details of CEO/President (An individual grade report will be issued to you at the end of the Programme, with a copy also sent to your Chief Executive Officer/President).
Emergency Contact Details
Relationship with AYIM participant:
Please note that you will be required to complete and sign an
Indemnity & Undertaking Form on the first day of course.
To ensure that the 10th AYIM applicants meet
the admission criteria, as well as to maintain
a diversified distribution of participants,
all registrations received will undergo a
Please take note that participants
should confirm their air tickets and hotel
accommodation ONLY after they have
received the Programme Confirmation
e-mail from the Singapore College of
We will inform the participants by 30
August 2019, if the 10th AYIM programme
is confirmed and if you have been
accepted into the programme.
Programme Fee Per Participant
The fee covers participation in all programme activities and study materials. The fee does not cover airfares and hotel accommodation.
Early Registration Fee (extended to 31 July 2019)
Regular Fee (after 31 July 2019)
SGD 910.00 (USD 650.00)
SGD 1050.00 (USD 750.00)
You will be informed of the status of your registration. Please do not book your air ticket until confirmation of programme is received.
I wish to register for
Total Fees Payable
Mode of Payment
Cancellation / Substitution Policy
Any cancellation request received in writing
before 28 June 2019 will be eligible for a
full refund. Thereafter, any cancellation will
not be eligible for any refund. However, the
participant may be substituted at any time,
before 13 September 2019.
Please check and print a copy of the completed online Registration Form, if needed, before submission.
The Programme Manager - Singapore College of Insurance (SCI) requires an individual's personal details for use in connection with this course registration purpose.
Please thoroughly check to ensure the correctness of all particulars, including the programme details, before you submit your registration.
For any participant who does NOT submit this registration personally, the individual concerned must ensure that he or she has given prior consent to anyone who does it on his or her behalf. The SCI does not take any responsibility for any such action.
I give consent to the holding, processing and using of my personal details provided for my programme registration purpose with the SCI.