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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 25 / 28

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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY

Gate No. 3, First Floor, Jeevan Tara Bldg., 5, Parliament Street, New Delhi – 110 001. Ph. No. 3364711

SURVEYOR/ LOSS ASSESSOR IDENTITY CARD

     I.D. No.: _______

Name: _________________________________________

Passport

Photo

Address: House No. ________Street__________________

    District ___________Town/ City _____________

    State _____________ Pincode _______________

Surveyor Licence No.: _______ Valid Till: ___________

Departments Allocated & Category:

Depts

Fire

Mrn Cargo

Mrn Hull

Engg.

Motor

Misc.

LOP

Category

Signature of the

Authorised Signatory: ______________Licence Holder

BACK

1.

Please surrender this card on expiry/ suspension/ cancellation.

2.

The Licence holder must inform Insurance Regulatory and Development Authority immediately if this card is lost or stolen.

3.

This card is the property of the Insurance Regulatory and Development Authority and is not transferable.  

4.

If this card is found please return to found please return to the Insurance Regulatory and Development Authority’s Office.

5.

Warning: Misuse of this card is an offence.

FRONT

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