X hits on this document

Word document

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 8 / 28

73 views

0 shares

0 downloads

0 comments

8 / 28

INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY

FORM - IRDA – 2 – AF (Regulation 3(a))

APPLICATION FOR A LICENCE TO ACT AS SURVEYOR & LOSS ASSESSOR

To

Passport Size Photo.

(3+1)

Insurance Regulatory and Development Authority

Gate No. 3, First Floor, Jeevan Tara Bldg.,

5, Parliament Street, New Delhi-110 001.

Telephone No. 3364711.

Sir,

1.

I request that a licence to act as a Surveyor and Loss Assessor may be granted to me for the following classes.

Depts

Fire

Mrn Cargo

Mrn Hull

Engg.

Motor

Misc.

LOP

Please tick

2.

I enclose a Demand Draft No. ------------- -Dated-------------Drawn on -----------------------

showing the payment of fee.

3.

I hereby declare that: (wording for affidavit – duly notorised or non-judicial paper)

i)

I have not been found to be unsound mind by a Court of competent jurisdiction

ii)

I have not been found guilty of criminal misappropriation or criminal breach of trust or cheating or forgery of an abetment or attempt to commit any such offence by a Court of Competent Jurisdiction,  

iii)

I have not been found guilty of or to have knowingly participated in or conceived at any fraud/dishonestly or misrepresentation against an insurer or an insured in the course of any judicial proceeding relating to any policy of insurance or the winding up of an insurance company or in the course of any judicial proceeding relating to any policy of insurance or the winding up of an insurance company or in the course of any investigation of the affairs of an insurer,

iv)

I shall not violate the code of conduct specified by the regulations made by the Authority.

v)

I possess the requisite qualifications and practical training as specified by the regulations made by the Authority.

vi)

I have passed such examination as specified by the regulations made by the Authority.

vii)

I enclose 4 passport size photographs.  

4.

I also declare that the particulars given below are true:

(IN BLOCK LETTERS)

a.  Full Name (in Hindi & English)------------------------------------------------------

    Shri/Smt/Kum.------------------------------------------------------

b.  Father’s/Husband’s Name------------------------------------------------------

c.  Full address in Hindi with PIN CODE ------------------------------------------------------

Document info
Document views73
Page views73
Page last viewedThu Dec 08 19:30:14 UTC 2016
Pages28
Paragraphs961
Words7503

Comments