Please print out, complete & send/fax to the below address.
q I
want to join Justitia
Membership
Application
Form
I/WE......................................................................................................
Name of Firm or
Sole Practitioner
Of
.........................................................................................................
.........................................................................................................
Address
E-Mail
...................................................................................................
Being Barrister(s) and/or Solicitor(s) carrying on practice in New Zealand
hereby apply the become a member of the Justitia Mutual Association
Incorporated.
I/We understand that membership
entitles me/us to apply for Professional Indemnity Insurance under the Professional
Indemnity Insurance Scheme arranged by the Association.
My/Our entry fee of $57.50 (including
$7.50 GST) is enclosed.
Tax Invoice for GST
No. 16-240-634
Signed
......................................................................
Date
......................................................................
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