IIA Membership Registration FormThis is for information gathering to register for India Insurtech Association (IIA) Please enable JavaScript in your browser to complete this form.Membership Category *Membership CategoryStartupCorporateCompany Revenue *Company RevenueMore Than 5Cr per YearLess Than 5Cr per YearIndividualCompany Name (Name of Legal entity) *Company Type *InsurTechHealthTechBrokerOthersCompany Representative *Company Representative Email ID *Company Representative Designation *Company Representative Phone Number *Company Incorporation License Number (CIN)Company GSTIN (If no GST Number, Please Input "unregistered") *Company Address *Company Website (Optional)Company LogoCompany LogoPermission to use it from the webWill email it to youSharing a shared folder linkCompany logo shared folder link (optional)Any company becoming a member is responsible for compliance with all regulations of the Government of India and/or any other local regulations *I AgreeSubmit