(a) Are you employed? If yes, please give details.
Are you under the employment of a Government/Semi-Government Organisation of any other Public Sector Undertaking, Private Organisation? Give details and attach No Objection Certificate of your present employer.
Experience: Job experience in previous employment
Have you ever held a licence? If so, state number and date and attach a photocopy of the Licence No., SLA date of issue. If the Licence is required in the name of the Sole Proprietorship Firm, full name and address of the firm under which the individual carried on purposes to carry on the work should also be mentioned here.
Signature of the Applicant
Draft in favour of Insurance Regulatory and Development Authority, payable at New Delhi.
Degree/ Diploma attested by Notary/ Magistrate only.
Answer of Question S.No. 13 of the application is a must. Enclose No Objection Certificate of your employer.
Affidavit duly notarised against S.No. 3 of the application form is a must.
Self addressed envelop of 4.5” x 10” with Rs.17/- postage stamps.
Please enclose attested documents in response to Q. No.’s 5, 8, 9 & 10 the answers to which are a must.
Please attach 4 passport size photographs with the application.
The attention of the applicant is drawn to Section 102 of the Insurance Act 1938, which provides that whoever in any document required for the purpose of any of the provisions of the Act, will fully makes statement false in any material particulars knowing it to be false, shall be punishable with the imprisonment for the terms which may extend to three years or with fine which may extended to one thousand rupees or with both.
An individual can apply for only one licence, which will entitle him to act as a Surveyor/ Loss Assessor for any insurer.
Any correction or alteration made in answer to the questions in the application should be initialled by the applicant.
An applicant must be atleast 18 (eighteen) years of age on the date of submission of the application. In the case of any applicant declaring him at is 18 years the exact date of birth of falling in the year or birth should be stated against item 4 of the application. If require the applicant shall furnish proof age.
The fee as specified in the Regulation made by the IRDA should be paid by means of Account Payee Demand Draft in favour of Insurance Regulatory and Development Authority, New Delhi drawn on the Indian Overseas Bank, Parliament Street, New Delhi.