10/4/21, 2:07 PM Registration Confirmation

 
 |  Home   |   
Contact Us   |   
Forgot my Password?   |   
Logout   |

  Paybill No: 830300 

 
  

  RENEWAL CONFIRMATION : Registration
 for IMPERIUM INSURANCE AGENCY - IRA/05/40786/2022  - 2022
  

1.  Applicant Details  * Renewal   Online Ref:  537313886   

Applicant Name:   IMPERIUM INSURANCE AGENCY  Telephone Number (s):   0702363690 

Registered Office Postal Address:   P.O. Box 38560 - 00100, Nairobi GPO  Mobile Number (s):   0702363690 

Agent Type:   Company  Email Address:   BONUMINSURANCE@GMAIL.COM 

Registration for:   2022  Certificate of Incorporation:  

2.  Individual Details / Partners / Shareholders

Full Name Nationality ID or Passport No. Soft Copy of ID or Passport No. Type

1. IAN SIMBA MORANGI  Kenya  33146057  12917PMTapScanner 04-23-2021-08.14(1).pdf   Original 

3.  Authorised to Represent: - Insurance Firms

Insurance Firm Certificate by Insurer (Soft Copy) Statement of Business (Soft Copy) Type

4.  Principal Officer - IAN SIMBA MORANGI

ID or Passport No.  * Year of Birth Academic Qualifications Professional Qualifications (attach Certificate) Insurance Experience
33146057  1996  DIGREE     

5.  Calendar year for which registration was first issued:  

2021  Calendar year up to which you have been issued:  
0

6.  Nature of Applicant's Other Business / Profession (if any):  

7.  Has the applicant ever been:-

Convicted of any offence involving fraud or dishonest?  

Yes    
No Found to be of unsound mind by any court of competent jurisdiction?  
Yes    
No

8.  Has the applicant (individual, partners or directors) during the past 10 years been adjudicated bankrupt or taken the benefit of any law for relief of bankrupt or insolvent debtors or compound with creditor or
made any assignment of remuneration for the benefit of creditors?

  
Yes    
No If the answer is in the affirmative, give details including dates:-   

9.  Does the applicant, or any of the partners or any of the directors or shareholders or employees, directly or indirectly hold any shares or have a controlling interest or is director or any member of the
insurance industry,
i.e - Insurer, Broker, Claims Settling Agent,Insurance Surveyor,Loss Adjuster,Loss Assessor,Risk Manager?

  
Yes    
No If the answer is in the affirmative, give full particulars:-   

10.  Does any member of the insurance industry or partner, director or employee thereof, directly hold shares in or have any other financial or controlling interest in the affairs of the applicant?

  
Yes    
No If the answer is in the affirmative, give full particulars:-   

11.  In case the applicant (being a company) is a subsidiary of another company, is there other member of the insurance industry which is a subsidiary or a parent to that company?

  
Yes    
No If the answer is in the affirmative, give full particulars:-   

12.  Does the insurer or broker pay, in respect of the business introduced by the applicant, any other amount, over and above the agency commission, profit commission, salary, reimbursement of office
expenses or otherwise?

  
Yes    
No If the answer is in the affirmative, give full particulars:-   

13.  Payment Details

Fee:  0   
Penalty for Late Renewal:  0   
Irregular Renewal Fee (0):  0

Payment Mode Amount Paid Transaction Ref. - If paid via bank, attach bank slip Date of Transaction

MPESA  2000  PJ40R6AENK(PJ43RKJ1TR)  10/4/2021 

  Licence Delivery - Specify how you want IRA to deliver your Licence

Deliver Mode *  Delivery Address *

  Registered_Mail  NAIROBI, P.O. Box 38560 - 00100, Nairobi GPO 

   I hereby certify that the statements contained herein are true and accurate to the best of my knowledge and belief.
Further, I undertake that any alterations in particulars stated herein will be promptly
communicated to the commissioner of insurance.

Submitted? 
Yes - 10/4/2021 2:06:52 PM

 Talk to Us:   |  Tel: (254)-020-4996000, 0719 047 000  |    Toll Free No: 0800 724499 

online.ira.go.ke/viewapp.asp?version=5&b_version=5.0 (Windows NT 6.3) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/94.0.4606.61 Safari/537… 1/2
10/4/21, 2:07 PM Registration Confirmation

online.ira.go.ke/viewapp.asp?version=5&b_version=5.0 (Windows NT 6.3) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/94.0.4606.61 Safari/537… 2/2