Application for Membership Form

1Section A
2Section B

To be completed by the employee when eligible in BLOCK LETTERS

Employee Name

Email Address

Phone

Name of Employer

I, the undersigned hereby apply for admission for membership of the above mentioned Scheme. I agree to be bound by the provision of the said Scheme in force from time to time and my employer is hereby authorized to deduct from every payment of salary due to me the amounts required to be contributed by me in terms of these provisions. I further agree to submit my Birth or Baptismal Certificate to the NICO Life Insurance Company Limited, Blantyre, as evidence of my date of birth, or should neither of these certificates be available to me, such other evidence as may be required by the said Insurance Company.

Date of application

Name of witness

Address of witness

Signature of Witness

Name of Employee

Address of employee

Signature of Employee

Attachments

ABOUT ONE NICO CUSTOMER PORTAL

With the One NICO customer portal customers of NICO Group will have the ability to track their support requests and the answers or resolutions they received from past requests,enabling you to use the portal as a knowledge source of all things NICO and avoid asking the same questions again. With this customer portal you'll be able to manage and track all your applications and requests, giving you confidence that your concerns and questions have been heard and are being addressed.