The individual details of all new the persons in the Company/ Firm be enclosed as per Form “3A-AF”attached.
Signature of applicant
Name of Firm/company………………..
Seal of the Company/ Firm
Name of place………………..
(See Notes on the reverse)
Draft in favour of Insurance Regulatory and Development Authority, payable at New Delhi.
Copy of previous licence.
Degree/ Diploma attested by Notary/ Magistrate only for new directors/ partners of the company/ firm.
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.
Work Performance report
Please enclose Form “3A-AF” complete in all respect along with attested photocopies of the documents in respect of all new director/ partners/ employees of the company/ firm.
The attention of the applicant is drawn to Section 102 and 105B of the Insurance Act 1938, which provides that whoever in any document required for the purpose of any of the provisions of the Act, willfully 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.