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APPLICATION FOR AFFILIATE MEMBERSHIP
 
Please complete and forward to your local branch or ICS head office
INSTITUTE OF CHARTERED SHIPBROKERS
85 Gracechurch Street, London EC3V 0AA, Telephone : +44(0)20 7623 1111, Fax : +44(0)20 7623 8118
Email: membership@ics.org.uk
PERSONAL DETAILS
Title :
Surname :
Given Name :
Home Address :
Address 1 [Optional] :
Address 2 [Optional] :
City :
Country :
Post Code :
Telephone No
 :
Fax [Optional] :
Mobile [Optional] :
E-mail :
I Completed Foundation Diploma or PQE in :      
Total fee due (£) : £
Remittance, payable to INSTITUTE OF CHARTERED SHIPBROKERS, must be in Sterling, no other currency will be accepted.
Remit either by Cheque drawn on a Bank with a U.K. Branch or by a Bank Transfer ensuring that ICS receives the Gross Amount (i.e. ALL CHARGES FOR YOUR ACCOUNT).
Bank Details : National Westminster Bank PLC. (Bishop’s Gate Branch)
Bank Sort Code : 50-00-00 BIC NWBK GB 2L IBAN GB55 NWBK 5000 0015 4792 34 
Account Number : 15479234
Institute of Chartered Shipbrokers
METHODS OF PAYMENT
Payment details
Cheque
Bank Transfer
Credit/Debit Card
Credit/Debit Card Details
Name on card :
Number :
Security No :
Expiry Date : (MM/YY)
Issue Number (Debit card only) :
3% commission will be charged on all card transactions.(AMEX not accepted)

   
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