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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 13 / 28

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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY

FORM - IRDA – 2 – LF (Regulation 3(c))

NOT TRANSFERABLE

LICENCE NO. …………………….

LICENCE TO ACT AS A SURVEYOR/ LOSS ASSESSOR UNDER

THE INSURANCE ACT, 1938

Passport size Photo

Mr./ Mrs./ Miss……………………………………...

Address House No.……………Street………………

Town/ District ………… State……….Pincode…….

* working as sole proprietor of ……………………………………………… ……………………..having paid the specified fee and having made the necessary declaration is hereby authorised under Section 64-UM of the Insurance Act, 1938 to act as surveyor/ loss assessor for five years from …………………………………………………..

This Licence will expire on ………………..

Name ……………………………………… are allocated the following departments and category:

Depts

Fire

Mrn Cargo

Mrn Hull

Engg.

Motor

Misc.

LOP

Category

New Delhi, dated the ……….. 20…..

Chairperson/ Designated Official

Insurance Regulatory and Development Authority

* (Strike out if not required)

(See Notes on the reverse)

Notes

1.

If it is desired to renew this licence a further for a period, the procedure laid down in Rule 56 of the Insurance Rules, shall be followed, and an application for renewal should reach the Insurance Regulatory and Development Authority atleast thirty days before the licence expires.

2.

This licence authorises the licence holder to act as a surveyor/ loss assessor for any registered insurer and therefore, no identifying mark or note of any description by which the identity of an insurer might be established should be placed on the licence.

3.

No correction in this licence will be valid unless initialled by the Chairperson, Insurance Regulatory and Development Authority or a person authorized by him in this behalf.

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