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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 3 / 28

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5.

Did the Firm/Company ever No………………………………...           hold a licence, if so state number and date.Date………………………………

Yours faithfully

Signature of applicant

Designation

Name of Firm/company………………..

Seal of the Company/ Firm

Name of place………………..

Dated the………………….                                       

(See Notes on the reverse)

CHECK LIST

Please ensure:

1)

Draft in favour of Insurance Regulatory and Development Authority, payable at New Delhi.

2)

Degree/ Diploma attested by Notary/ Magistrate only.

3)

Affidavit duly notarised against S.No. 3 of the application form is a must.

4)

Self addressed envelop of 4.5” x 10” with Rs.17/- postage stamps.

5)

Please enclose Form “1A-AF” complete in all respect along with attested photocopies of the documents.

Notes

1.

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.

2.

A firm or company can apply for only one licence which will entitle it to act as a surveyor/ loss assessor.

3.

Any correction or alteration made in the application should be initialled by the applicant.

4.

A fee as specified in the regulations should be paid by means of Account Payee Demand Draft in favour of Insurance Regulatory and Development Authority, New Delhi drawn on Indian Overseas Bank, Parliament Street, New Delhi.

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