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
	General Reinsurer of the Year
	Lifetime Achievement Award
	Risk Manager of the Year
	Innovation of the Year
	Life Insurance Company of the Year
	Broker of the Year
	Service Provider of the Year
	Educational Service Provider of the Year
	Reinsurance Broker of the Year
	Loss Adjuster of the Year
	Reinsurance Industry Contribution Award
	Corporate Social Responsibility Award
	Life Reinsurer of the Year