Producer Registration

Username*

Email*

First Name

Last Name

Address 1*

Address 2

Country*

City/Town

State/County

Postcode/Zip*

Store Phone*

NIC Number*

Are you an existing client of Berendina Micro Investments Company Limited (BMIC) ?*

If yes, Client No (If BMIC Client)

BMIC Branch

Please upload scanned image of NIC and bank account here ?*

Password*

Confirm Password*

* Agree  Terms & Conditions