Mid-Year National Agency Convention 2024 - Fukuoka

CONGRATULATIONS!!!

You are cordially invited to the Mid-Year National Agency Convention 2024 – Fukuoka

Travelling Date: 01 – 06 October 2024

IMPORTANT NOTICE

Before proceeding with your registration, please ensure:-

Your passport must have at least 6 months validity from date of return from Fukuoka, i.e. expiry date AFTER 06^th April 2025. *You may upload your current passport and renew after submission
NO changes are allowed after you have made the selection either to attend the Agency Convention Trip or not attending.
Please scan / snapshot & upload your passport personal data page with file size not more than 6MB. Sample as attached.
Registration will end on 21 July 2024 (Sunday) at 11.59pm.

Mid-Year National Agency Convention 2024 – Fukuoka – Online Registration

"*" indicates required fields

Particulars Of Participant

Full name as per passport*

Race*

Nationality*

Gender*

Date of Birth*

Branch*

Agency Name*

Agency Code (eg: 10001234)*

Mobile phone no.*

Confirm attendance*

Reason for not attending*

Travel Insurance Particulars (during this Fukuoka Trip)

Beneficiary Name*

Relationship*

Beneficiary NRIC (without “-“) or Passport No*

Beneficiary's Mobile No.*

Beneficiary's Correspondence Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficiary's Email Address*

Emergency Contact Person

Emergency Contact Person Name*

Relationship*

Emergency Contact Mobile No.*

Example +60123456789

Guest Particulars Part 1

Guest Full name as per passport*

Race*

Nationality*

Gender*

Date of Birth*

Mobile phone no.*

Guest Travel Insurance Particulars (during this Fukuoka Trip)

Beneficiary Name*

Relationship*

Beneficiary NRIC (without “-“) or Passport No*

Beneficiary's Mobile No.*

Beneficiary's Correspondence Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Beneficiary's Email Address*

Emergency Contact Person

For guest

Emergency Contact Person Name*

Relationship*

Emergency Contact Mobile No.*

Example +60123456789

CONGRATULATIONS!!!

You are cordially invited to the Mid-Year National Agency Convention 2024 – Fukuoka

Mid-Year National Agency Convention 2024 – Fukuoka – Online Registration

Particulars Of Participant

Particulars Of Participant

Travel Insurance Particulars (during this Fukuoka Trip)

Emergency Contact Person

Additional Guest

Guest Particulars Part 1

Guest Particulars Part 2

Guest Travel Insurance Particulars (during this Fukuoka Trip)

Emergency Contact Person