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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 2 / 28

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3.

It is also declared that the particulars given below are true.

1.

Full name of the applicant1. Company/ Firm ________________

           (In Block Letters)________________________________

2.  Full Address 2.  ______________________________

_________________________________

3.  The name of all the persons, with   3.  ______________________________

    their addresses stating to each case the date          ________________________________

    of birth and whether the person            _________________________________

    claims to :-   

(a)

have been in practice as a surveyor/loss(a) ______________________________

assessor on the 31st May, 1970, or _________________________________

(b)

hold a degree of a recognised university (b) ______________________________

in any branch of engineering, or_________________________________

(c)

be a fellow or associate member of the (c ) ______________________________

Institute of Chartered Accountants of _________________________________

India or Institute of Cost and Works _________________________________

Accountants of India, or_________________________________

(d)

posses actuarial qualifications or hold a (d) ______________________________

degree or diploma of any Indian University_________________________________

or Institute in relation to insurance, or_________________________________

(e)

hold a diploma in insurance granted (e) ______________________________

or recognized by the Government, or _________________________________

(f)

possess any of the technical qualifications(f) ______________________________

mentioned in Rule 56-A._________________________________

(N.B. 1: In the case of each of the partners/directors claiming to come under item (a) above and not being eligible to come under any of the items (b)  to (f) above, a declaration in the form given in the Annexure to this Form duly filled in and sworn before a Magistrate, Notary Public or Justice of the Peace should be forwarded with this Form and in the case of each of the partners/Directors claiming to come under any one of the items (b) to (f) above, either the original diplomas/ certificates with one of the attested copy each, or copies of the original diplomas/ certificates duly attested by a Magistrate, Notary Public or Justice of the Peace should be enclosed.  Where original diplomas/ certificates are sent, they will be returned after perusal, but no responsibility can be accepted for loss or damage of such originals

N.B. 2: Where the person does not already hold a licence then an application from such a person should accompany this application).

(If the space above is insufficient particulars may be given in a separate sheet which should be signed by the applicant)

4.

The individual details of all the persons in the Company/ Firm be enclosed as per Form “1A”attached.

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