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.

Membership Type *

New Membership

Member Renewal

Type of Membership Requested *

Full Class C Member

Full Class D Member

Full Class E Member

Associate Member

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,

Term Insurers and Reinsurers Name

, 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.

Company Name

Company Address

Dated this

Signed by or on behalf of the above-named:

Authorized Signatory Name

Authorized Signatory Title

Authorized Signatory

Authorized Signatory

Signed by or on behalf of the above-named:

Payment Methods *

Cheque

Money Order

Electronic Bank Transfer

Payment Information

Price

Payment Method

Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Bank ABA Routing Number*

Bank Account Number*

Bank Account Type*

Bank Name*

Account Holder Name*

Security*

Payment Information

BILTIR Fees:

Member fees for the 2019/20 membership period are Associate Member: $8,000 and the following full member options: Class C Member: $8,500, Class D Member: $10,500, Class E Member: $10,500.

The membership period runs from August 1 to July 31 each year. If you have any questions concerning BILTIR membership, contact secretary@biltir.bm. Please see the payment options below.

Check or Money Order:
Please make payable to Bermuda International Long Term Insurers and Reinsurers and mail to: BILTIR, P. O. Box HM 2536, Hamilton HM BX. Please include reference: renewal fee/company name on the check or money order.

Wire Transfer Payments:

HSBC BANK USA

ABA: 021001088

S.W.I.F.T. Code MRMDUS33

for further credit to beneficiary bank: HSBC Bank Bermuda Limited, Hamilton Bermuda,

S.W.I.F.T. Code BBDA BMHM

For Bermuda Beneficiary Account 011-045119-501

In the name of Bermuda International Long Term Insurers & Reinsurers

REFERENCE: Membership fees/Company Name.

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

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

Payment Information

Contact Us