Membership Application

Type of Membership Requested *

Total Statutory Asset Base (full members only) *

<5bn

>5bn & <25bn

>25bn & <50bn

>50bn

Company Name *

Address1 *

Address2

City *

Country *

State/Region *

Postal/Zip Code *

Company Phone *

Company Representative *

Representative Email *

Representative Phone *

Comment

Form A

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

, apply to be admitted as a Member of Bermuda International Long

Term Insurers and Reinsurers.

We agree to become a Member subject to the Memorandum of Association and the Bye Laws of the Company and authorize you to enter the following name and address in the Register of Members of the Company:

Company Name *

Company Address *

Authorized Signatory

Authorized Signatory

Dated this *

Authorized Signatory Name *

Authorized Signatory Title *

PROXY (For Full Members only)

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

Term Insurers and Reinsurers Name

, a Member of Bermuda International Long Term Insurers and

Reinsurers appoint

Reinsurers Appointed Name

or failing him/her

Appointed Name

as our

proxy to vote on our behalf at all meetings of the Company and at any adjournment thereof.

Signed by or on behalf of the above-named:

Group organizations chart, including entity description (operating, holding, insurance, etc) *

List of Board of Directors and Officers of the Company *

Create an account

BILTIR Membership Application

New Membership

Companies are invited to become a member of Bermuda International Long Term Insurers and Reinsurers. Please complete this membership application together with the Form A and Proxy below and submit it with the membership fee payable to BILTIR.

Membership Renewal

Existing member companies wishing to renew on-line, please complete the following information and submit your payment using one of the options listed below.

If there have been any changes to your company details, representative or proxy information, please complete the Form A and Proxy below and submit to BILTIR with your membership renewal fee.

Form A

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

, apply to be admitted as a Member of Bermuda International Long

Term Insurers and Reinsurers.

We agree to become a Member subject to the Memorandum of Association and the Bye Laws of the Company and authorize you to enter the following name and address in the Register of Members of the Company:

PROXY (For Full Members only)

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

, a Member of Bermuda International Long Term Insurers and

Reinsurers appoint

or failing him/her

as our

proxy to vote on our behalf at all meetings of the Company and at any adjournment thereof.

Signed by or on behalf of the above-named:

Signed by or on behalf of the above-named:

Payment Information

Contact Us

Login to your account

Create an account

BILTIR Membership Application

New Membership

Companies are invited to become a member of Bermuda International Long Term Insurers and Reinsurers. Please complete this membership application together with the Form A and Proxy below and submit it with the membership fee payable to BILTIR.

Membership Renewal

Existing member companies wishing to renew on-line, please complete the following information and submit your payment using one of the options listed below.

If there have been any changes to your company details, representative or proxy information, please complete the Form A and Proxy below and submit to BILTIR with your membership renewal fee.

Form A

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

, apply to be admitted as a Member of Bermuda International Long

Term Insurers and Reinsurers.

We agree to become a Member subject to the Memorandum of Association and the Bye Laws of the Company and authorize you to enter the following name and address in the Register of Members of the Company:

PROXY (For Full Members only)

TO: The Directors of Bermuda International Long Term Insurers and Reinsurers (the “Company”)

We,

, a Member of Bermuda International Long Term Insurers and

Reinsurers appoint

or failing him/her

as our

proxy to vote on our behalf at all meetings of the Company and at any adjournment thereof.

Signed by or on behalf of the above-named:

Signed by or on behalf of the above-named:

Payment Information

Contact Us