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INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY - page 9 / 28

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d.  Full address in English with  PIN CODE ------------------------------------------------------

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5.

Qualification

a)

Academic/professional---------------------------------------------------

b)

Insurance ---------------------------------------------------

c)

Training attended (Nature – duration)---------------------------------------------------

6.

Communication

Phone Office

Phone Res.

Fax

Pager

Mobile

E-Mail

7.

Date of Birth in Christian Era           -----------------------------------------------------

8.

Insurance Surveyor & Loss Assessor Examination Details

Dt. Of Exam

Roll No.

Centre

Institute conducting the Exam

Result

9.

Practical Training Details (Please enclose the certificate of training obtained from the surveyor/ survey firm)

Name of Surveyor/ Survey Firm

Departments Allocated to the Surveyor/ Survey Firm

Category Awarded to the Surveyor/ Survey Firm

Period of training undergone (Please mention dates)

Name of person(s) under whom training undertaken

Areas covered

Result

10. Experience:

a) Whether the applicant is employed with any insurance company: ____________    

b) Job Experience in previous employment other than insurance surveyor, if any: ___

c) Details of other business/ employment: _______________

11.

Qualifications whether the applicant possesses any of the following qualification; if so give details and also enclose either the original diploma certificate with one copy each or copies of original diploma duly attested by a Magistrate, Notary Public or Justice of Peace.  (Where original diploma/ Certificates are sent they will be returned after perusal but no responsibility can be accepted for loss or damage of such originals).

(a)

holds a degree of a recognised University in any branch of Engineering.

(b)

Is a fellow or associate member of the Institute of Chartered Accountants of India or the Institute or Cost and Works Accountants of India.

(c)

Actuarial qualifications or holds a degree or diploma of any recognised university or institute in relation to insurance.

(d)

Holds a diploma in insurance granted or recognised by the Government.

(e)

Possess any of the technical qualifications mentioned in Rule-56-A.

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