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Form A[See regulation 4]Insurance Regulatory and Development Authority of India (Registration of Corporate Agent) Regulations, 2015Application for grant of Certificate of Registration to act as Corporate Agent1. Instructions for filling up the form:
(1)It is important that before this application form is filled in, the regulations made by the Authority are studied carefully.(2)Applicants must submit a duly completed application form together with all appropriate, supporting documents to the Authority.(3)Application for Registration will be considered only if it is complete in all respects.(4)Applicants should sign the applications themselves,(5)Information which needs to be supplied in more details may be given on separate sheets attached to the application form.Particular of the Applicant1.1Name of the Applicant:_________________________________________1.2Address - Principal Place of business I Registered Office.
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E-mail |
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Fax No. |
| Website Address |
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1.3Address for Correspondence:
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| Pin Code |
E-mail |
| Tel No |
Fax No. |
1.4Name and Designation of the Principal Officer:1.5Details of proposed/existing branch office/s where the applicant proposes to distribute insurance
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Address |
Name of the Specified Person |
Educational Qualification of the SpecifiedPerson
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Exam Pass Certificate No. of the SpecifiedPerson
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Note. - In case the applicant proposes to have more than one specified person in a branch, the details of all such specified person in a branch, the details of all such specified person shall be provided2. Organisation - Structure
2.1Status of the Applicant. - (e.g. Limited company-Private/Public, LLP/ Cooperative Society. If listed, names of Stock Exchanges and latest share price to be given)
| Category of Applicant |
Details of Registration |
Date of IncorporationDD-MM-YYYY
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Place of Incorporation |
Name of stock exchanges (In case of listedCompany)
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2.2List of major shareholders (holding 5% and above of applicant directly or along with associates)(The information is required to be furnished by the applicant falling under category 4(l)(ii) of the regulations)
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Share holding as on:____________________________ |
| Name of shareholder |
No. of Shares held |
% of total paid up capital of the company |
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2.3Particulars of all Directors/Partners
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Designation/ Position |
Qualification |
Share in applicant Company |
Directorship in other companies |
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2.4Name and activities of associate companies/concerns
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Address |
Type of activity Handled |
Nature of interest of Promoter/ Director |
Nature and interest of applicant company |
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Whether any one or more directors/shareholders of the associate companies/ concern are interested in the applicant's business, if yes please provide the nature of interest2.5Name and Address of the Principal bankers of die applicant -(In case the applicant is a bank, please provide the details only in case Principal Banker is other than the applicant)2.6Name and address of the statutory auditors3. Business Information
3.1Three years business plan document with projected volume of business in terms of premiums in each category
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Life Insurance |
General Insurance |
Health Insurance |
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3.2Organization Chart separately showing functional responsibilities to be enclosed.3.3Details of infrastructure like office space, equipment and manpower available with the applicant.3.4Any other information considered relevant to the nature of services rendered by the applicant.4. Financial Information. - (The information is required to be furnished by an applicant which is falling under regulation 4(l)(ii) of these regulations)
4.1Capital Structure (Rs. in lakhs)
| Capital Structure |
Year prior to the Preceding year of Current year |
preceding year |
current year |
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(a) Authorized Capital(b) issue capital(c) Paid-up capital(d) Free reserves (excluding re- valuation reserves)(e) Total (c) + (d)Note: - 1. In case of LLPs, please indicate capital minusdrawings and/or loans to partners.2. In case of LLPs, please indicate the financial position, meansand net worth of the partners.
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|}4.2Net Worth of the applicant company (in rupees lakhs)Note. - Please enclose Chartered Accountant's certificate certifying the net worth of the applicant. The certificate should be a latest one and should not be more than thirty days old.5. Other Information, If Any
5.1Details of all settled and pending disputes**:
| Nature of dispute |
Name of the party |
Pending/settled |
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** Attach sheet if required5.2Details, if any of cases filed in respect of any economic offences by the applicant or any of its Directors and/or any disciplinary action taken/initiated by any other regulator or government authorities in the last three years.5.3Declaration of Fit & Proper Criteria ( As per Annexure 1)6. Documents attached (as per Annexure 2)
7. Fee Payment:
Details of Payment:Name of the Bank:Mode of payment:NEFT/RTGS Date of Payment:Transaction Details along with number;Note. - A non-refundable fees Plus service Tax as specified in Regulation 1/ of IRDAI (Registration of Corporate Agent) Regulations, 20158. Undertaking
8.1Whether any person directly or indirectly connected to the applicant has been refused for the registration or license in the past or not
| Name of the Person |
Relationship with the applicant |
Date and Reason for refusal |
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For the purpose of this sub-clause, the expression"directly or indirectly connected" means a relative in the case of any individual, and in the case of a firm or Company or a body Corporate an associate, a subsidiary an interconnected undertaking or a group Company of the applicant.8.2Qualification & Experience Details of the Principal Officer of the Applicant
| Details of the Principal Officer |
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| Full Name |
Mention Mr/Mrs |
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| Address |
| Date of Birth |
Phone No |
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| Nationality |
Cell No |
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| Position in the organization |
Fax No |
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| Current Position Held from |
Email ID |
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| Description of Duties/Responsibilities |
| Qualifications Experience & Achievements |
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| Name of the Institute |
Country |
Qualification |
Year of Study |
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| Professional Qualification |
| Name of the Institute |
Country |
Qualification |
Year of Study |
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| Working Experience |
| Name of the Employer |
Nature of Business |
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Designation |
Description of Duties |
Period |
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8.3List of Specified Persons who will be responsible for Soliciting and Procuring Insurance Business
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Address |
PAN/ ADHAR No. |
Qualification (Including Insurancequalifications)
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Previous Employment |
Details of Responsibilities |
Exam pass Certificate issued by Examination Bodyas per Regulations
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Declaration(This declaration is to be signed by two of the directors, two of the partners as the case may be)I/We hereby apply for registration.I/We have gone through the Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015 and am/are satisfied that(a)I/We am/are eligible to apply for the corporate agency registration.(c)I/We declare that the information supplied in the application form is complete and correct.(d)I/We undertake that I/We shall not allow or offer to allow, either directly or indirectly, as an inducement to any person, any rebate of the whole or part of the remuneration earned by me/us during the registration period.(e)I/We undertake to service the run-off business on the books at the time of cancellation or non-renewal of registration.(f)I/We declare that I/we do not possess an insurance agent license or insurance broker registration or any other license/registration issued by the Authority.For and on behalf of_________________________NameDesignationAnnexure - 1[See regulation 7(2)(g)]Insurance Regulatory and Development Authority of India (Registration of Corporate Agent) Regulations, 2015Declaration and Undertaking of Principal officer/ Directors/ Managing Partners (A separate form needs to be submitted by each individual)
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Fit & Proper Criteria |
Yes/No (If Yes, furnish full details) |
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Have you ever registered or obtained licensefrom any of the regulatory authorities under any law such asSEBI, RBI, IRDA, PFRDA, FMC etc.
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Have you carried on business under any nameother than the name stated in this application
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Have you ever been refused or restricted by anyregulatory authority to carry on any business, trade, orprofession for which a specific license registration or otherauthorization is required by law.
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Have you been ever censured or disciplined orsuspended or refused permission or license or registration by anyregulatory authority to carry on any business activity
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Have you been subject to any investigations ordisciplinary proceeding or have been issued warning or reprimandby any regulatory authority
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Have you been convicted of any offence orsubject to any pending proceedings under any law
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Have you been banned from entry from anyprofession / occupation at any time
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Details of prosecution, if any, pending orcommenced or resulting in conviction in the past for violation ofeconomic laws and regulations '
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Details of criminal prosecution, if any. pendingor commenced or resulting in conviction in the past against theapplicant
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Do you attract any of the disqualificationsenvisaged under Section 164 of the Companies Act 2013?
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Have you been subject to any investigation atthe instance of Government department or agency?
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Have you at any time been found guilty ofviolation of rules / regulations / legislative requirements bycustoms / excise / income tax / foreign exchange / other revenueauthorities, if so give particulars
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Have you at any time come to the adverse noticeof a regulator such as SEBI. reversal/setting aside is ontechnical reasons like limitation or lack of jurisdiction, etc,and not on merit. If the order of the regulator is temporarilystayed and the appellate /court proceedings are pending, the samealso should be mentioned).
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Has any of your group company/associatecompany/related party been carrying any license issued by theIRDA
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Any other explanation/information in regard toitems I and II and other information considered relevant forjudging fit and proper criteria of the applicant
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UndertakingI confirm that the above information Is, to the best of my knowledge and belief, true and complete, I undertake to keep the Authority fully informed, as soon as possible, of all events, which take place subsequent to my appointment, which are relevant to the information provided above.SignatureNameDesignationDate:Place:Annexure 2Insurance Regulatory and Development Authority of India (Registration of Corporate Agent) Regulations, 2015Documentation to be attached for obtaining Fresh Corporate Agent Registration[See regulation 4 and Point 6 of the Form A]A. Submission of Completed Application.(a)Submission of relevant information as required in the FORM A.(b)Remittance of requisite fee by electronic mode as prescribed under Regulation 17 of IRDAI (Registration of Corporate Agent) Regulations, 2015.(c)Submission of charter documents of the applicant (Memorandum and Articles of Association/Byelaws as the case may be)(d)Declaration of Fit & Proper criteria from Principal Officer, Directors and Managing Partners (separately for each person) to be provided in the 'Fit and Proper Form as per annexure 1 '(e)Details of infrastructure along with supporting evidence thereof like ownership/lease agreement papers with regard to office space/ equipment/ trained manpower, etc. for the registered office and the branch offices at various locations.(f)Projections of administrative expenses,^salaries and wages and other expenses, draw the revenue account, the profit and loss account and the balance sheet for the projected 3 years.(g)Organization chart giving a complete picture of the company's activities like IT, underwriting, risk assessment, claims settlement, marketing, accounts, back office etc.(h)Board approved policy on open architecture(i)Bring on record any other information, which is relevant to the nature of services rendered by the applicant for the growth and promotion of insurance business.(j)Any other requirements as deemed necessary by the authority.B. Signatories(a)Two Directors of the applicant should sign the Application Form and the various formats mentioned above.(b)The above list of documents/requirements is indicative only and not exhaustive. The additional documents will be advised based on, pattern of shareholding, any other matter required as per IRDAI (Registration of Corporate Agent) Regulations, 2015 and views oI the Authority.C. Personal Presentation. - The applicant on fulfilling the given requirements to the satisfaction of the Authority may be required, if necessary, to appear before the Authority for a presentation of business plans in connection with the application.
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[See regulation 19]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Maintenance of Professional Indemnity Insurance1. The insurance cover must indemnify a corporate agent against:
a. any error or omission or negligence on their part or on the part of their employees and directors;b. any loss of money or other property for which the corporate agent is legally liable in consequence of any financial or fraudulent act or omission;c. any loss of documents and costs and expenses incurred in replacing or restoring such documents;d. dishonest or fraudulent acts or omissions by corporate agent's employees or former employees.2. The indemnity cover:
a. shall be on a yearly basis for the entire period of registration;b. shall not contain any terms to the effect that payments of claims depend upon the corporate agent having first met the liability;c. shall indemnify in respect of all claims made during the period of the insurance regardless of the time at which the event giving rise to the claim may have occurred.Provided that indemnity insurance cover not fully conforming to the above requirements shall be permitted by the Authority in special cases for reasons to be recorded by it in writing.3. The un-insured excess in respect of each claim shall not exceed five percent of the capital employed by the corporate agent in the business.
4. The insurance policy shall be obtained from any registered insurer in India who has agreed to:
a. provide the corporate agent with an annual certificate containing the name and address, including the registration number of the corporate agent, the policy number, the limit of indemnity, the excess and the name of the insurer as evidence that the cover meets the requirements of the Authority;b. send a duplicate certificate to the Authority at the time the certificate is issued to the corporate agent; andc. inform the corporate agent immediately of any case of voidance, non-renewal or cancellation of cover mid-term.5. Every corporate agent firm shall -
a. inform immediately the Authority should any cover be cancelled or voided or if any policy is not renewed;b. inform immediately the insurer in writing of any claim made by or against it;c. advise immediately the insurer of all circumstances or occurrences that may give rise to a claim under the policy ; andd. advise the Authority as soon as an insurer has notified that it intends to decline indemnity in respect of a claim under the policy.
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[See regulation 26]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Code of ConductI. General code of conduct1. Every corporate agent shall follow recognised standards of professional conduct and discharge their duties in the interest of the policyholders. While doing so -
(a)conduct its dealings with clients with utmost good faith and integrity at all times.(b)act with care and diligence.(c)ensure that the client understands his relationship with the corporate agent and on whose behalf the corporate agent is acting.(d)treat all information supplied by the prospective clients as completely confidential to themselves and to the insures(s) to which the business is being offered.(e)take appropriate steps to maintain the security of confidential documents in their possession.(f)No director of a company or a partner of a firm or the chief executive or a principal officer or a specified person shall hold similar position with another corporate agent.2. Every Corporate Agent shall
(a)be responsible for all acts of omission and commission of its principal officer and every specified person:(b)ensure that the principal officer and all specified persons are properly trained, skilled and knowledgeable in the insurance products they market:(c)ensure that the principal officer and the specified person don not make to the prospect any misrepresentation on policy benefits and returns available under the policy:(d)ensure that no prospect is forced to buy an insurance product:(e)give adequate pre-sales and post-sales advice to the insured in respect of the insurance product:(f)extend all possible help and cooperation to an insure in completion of all formalities and documentation in the event of a claim:(g)give due publicity to the fact that the corporate agent does not underwrite the risk or act as an insurer:(h)enter into agreements with the insurers in which the duties and responsibilities of both are defined.II Pre-sale code of conduct3. Every corporate agent or principal officer or a specified person shall also follow the code of conduct specified below:
(i)Every corporate agent/principal officer/specified person shall,-(a)identify himself and disclose his registration/certificate to the prospect on demand:(b)disseminate the requisite information in respect of insurance products offered for sale, if asked by the prospect:(c)disclose the scales of commission in respect of the insurance product offered for sale, if asked by the prospect:(d)indicate the premium to be charged by the insurer for insurance product for sale:(e)explain to the prospect the nature of information required in the proposal form by the insurer, and also the importance of disclosure of material information in the purchase of an insurance contract:(f)bring to the notice of the insurer any adverse habits or income inconsistency of the prospect, in the form of a confidential report along with every proposal submitted to the insurer, and any material fact that may adversely affect the underwritten decision of the insurer as regards acceptance of the proposal, by making all reasonable enquiries about the prospect:(g)inform promptly the prospect about the acceptance or rejection of the proposal by the insurer:(h)obtain the requisite documents at the time of filing the proposal form with the insurer: and other documents subsequently asked for by the insurer for completion of the proposal:(ii)No corporate agent/principal officer/specified person shall-a. solicit or procure insurance business without holding a valid registration/certificate:b. induce the prospect to omit any material information in the proposal form:c. induce the prospect to submit wrong information in the proposal form or documents submitted to the insurer for acceptance of the proposal:d. behave in a discourteous manner with the prospect:e. interfere with any proposal introduced by ant other specified person or any insurance intermediary:f. offer different rates, advantages, terms and conditions other than those offered by the insurer:g. force a policyholder to terminate the existing policy and to effect a new proposal from him within three years from the date of such termination:h. No corporate agent shall have a portfolio of insurance business from or person or one organization or one group of organizations under which the premium is in excess of fifty percent of total premium procured in any year:i. become or remain a director of any insurance company, except wit the prior approval of the Authority:j. indulge in any sort of money laundering activities:k. indulge in sourcing of business by themselves or through call centers by the way of misleading calls or spurious calls:l. undertake multi-level marketing for soliciting and procuring of insurance products:m. engage untrained and unauthorised persons to bring in business:n. provide insurance consultancy or claims consultancy or any other insurance related services except soliciting and servicing of insurance products as per the certificate of registration.o. Engage encourage , enter into a contract with or haver any sort of arrangements with any person other than a specified person , to refer, solicit, generate lead, advise, introduce,p. Pay or allow the payment of any fee, commission, incentive by any other name whatsoever for the purpose of sale, introduction, lead generation, referring or finding to any person or entity.III. Post-Sale Code of Conduct4. Every Corporate Agent shall -
a. advise every individual policyholder to effect nomination or assignment or change of address or exercise of options, as the case may be, and offer necessary assistance in this behalf, wherever necessary;b. with a view to conserve the insurance business already procured through him, make every attempt to ensure remittance of the premiums by the policyholders within the stipulated time, by giving notice to the policyholder orally and in writing.c. ensure that its client is aware or the expiry date of the insurance even if it chooses not to offer further cover to the client;d. ensure that renewal notices contain a warning about the duty of disclosure including the necessity to advise changes affecting the policy, which have occurred since the policy inception or the last renewal date;e. ensure that renewal notices contain a requirement for keeping a record (including copies of letters) of all information supplied to the insurer for the purpose of renewal of the contract;f. ensure that the client receives the insurer's renewal invitation well in time before the expiry dale.g. render necessary assistance to the policyholders or claimants or beneficiaries in complying with the requirements for settlement of claims by the insurer;h. explain to its clients their obligation to notify claims promptly and to disclose all material facts and advise subsequent developments as soon as possible;i. advise the client to make true, fair and complete disclosure where it believes that the client has not done so. If further disclosure is not forthcoming it shall consider declining to act further for the client;j. give prompt advice to the client of any requirements concerning the claim;k. forward any information received from the client regarding a claim or an incident that may give rise to a claim without delay, and in any event within three working days;l. advise the client without delay of the insurer's decision or otherwise of a claim; and give all reasonable assistance to the client in pursuing his claim,m. shall not demand or receive a share of proceeds from the beneficiary under an insurance contract;n. ensure that letters of instruction, policies and renewal documents contain details of complaints handling procedures;o. accept complaints either by phone or in writing;p. acknowledge a complaint within fourteen days from the receipt of correspondence, advise the member of staff who will be dealing with the complaint and the timetable for dealing with it;q. ensure that response letters are sent and inform the complainant of what he may do if he is unhappy with the response;r. ensure that complaints arc dealt with at a suitably senior level;s. have in place a system for recording and monitoring complaints.
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[See regulation 27]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Inspection of Corporate Agent1. Power of Authority to inspect. - The Authority may suo motu or upon receipt of information or complaint, appoint one or more of its officers as inspecting authority to undertake inspection of the books of accounts, records and documents relating to Corporate Agent for any of the following reasons:
(i)to ensure that the books of account, records and documents are being maintained by the corporate agent in the manner as may be specified by the Authority ;(ii)to inspect the handling of complaints received from clients or any other person, on any matter having a bearing on the activities of the corporate agent;(iii)to ascertain whether the provisions of the Act, as amended from time to time, and these Regulations are being complied with by the corporate agent;(iv)to inspect into the affairs of corporate agent, in the interest of the policyholders;(v)to examine the veracity of the complaint received;(vi)to investigate into the activities and conduct of the corporate agent.2. Notice before inspection. - (i) Before ordering an inspection under regulation 27, the Authority shall give not less than ten days' notice to the corporate agent.
(ii)Notwithstanding anything contained in clause (i), where the Authority is satisfied that in the interest of the policyholders no such notice should be given, it may by an order in writing direct that the inspection of the affairs of the corporate agent be taken up without such notice.3. Obligation of corporate agent on inspection. - (i) It shall be the duty of every corporate agent in respect of whom an inspection has been ordered under the Regulation and any other associate person who is in possession of relevant information pertaining to conduct and affairs of such corporate agent, including representative of corporate agent, if any, to produce to the inspecting authority such books of accounts and other documents in its custody or control and furnish him with such statements and information as the inspecting authority may require for the purposes of inspection.
(ii)It shall be the duly of every corporate agent and any other associate person who is in possession of relevant information pertaining to conduct and affairs of the corporate agent to give to the inspecting authority all such assistance and shall extend all such co-operation as may be required in connection with the inspection and shall furnish such information as sought by the inspecting authority in connection with the inspection.(iii)The inspecting authority shall, for the purposes of inspection, shall have power to examine on oath and record the statement of Principal Officer, any employees, directors, partners or person responsible for or connected with the activities of corporate agent or any other associate person having relevant information pertaining to such corporate agent.(iv)The inspecting authority shall, for the purposes of inspection, have power to obtain authenticated copies of documents, books of accounts etc. in respect activities of corporate agent, from any person having control or custody of such documents.4. Submission of Inspection Report to the Authority. - The inspecting authority shall, as soon as possible, but in any case not later than 30 days from the completion of the inspection, submit an inspection report to the Authority:
Provided that if directed to do so by the Authority, the inspecting authority may submit an interim report.5. Action on the Inspection Report. - The Authority may after consideration of the inspection report and after giving reasonable opportunity of hearing to the corporate agent, issue such directions as it deems fit in the interest of policyholders including.
(i)requiring the corporate agent to refund any monies collected as fees, charges or commissions or otherwise to the concerned clients along with the requisite interest;(ii)to refund monies and/or remuneration and/or commission paid by the insurer, to which, otherwise the corporate agent is not eligible to receive;(iii)prohibiting the corporate agent from operating in the insurance market for a specified period;(iv)Any other action as the Authority may deem fit.
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[See regulation 28)Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015I. Cancellation of Certificate of Registration of a Corporate Agent with Notice. - The Authority may suspend or cancel the registration of a Corporate Agent for any one or more of the following reasons:(i)suffers at any time during the period of the registration from any of the disqualifications specified under subsection (5) of section 42D of the Act, as amended from time to time,;(ii)violates the provisions of the Act, as amended from time to time, IRDA Act 1999 and any other rules, regulations, guidelines, directions issued in this regard by the Authority, such as:a. Fails to furnish any information relating to its activities as a corporate agent as required by the Authority;b. Furnishes wrong or false information; or conceals or fails to disclose material facts in the application submitted for obtaining a registration ;e. Indulges in rebates or inducements in cash or kind to a client or any of the client's Directors or other employees or any person acting as an introducer;d. Fails to comply with the Code of Conduct as specified in these regulations;e. Fails to comply with any of the conditions subject to which the registration has been granted.(iii)Resort to spurious calls or mis-selling;(iv)Aets in a manner detrimental to the interest of the policyholders or against public interest;II. Procedure to be followed for suspension or cancellation or Certificate of Registration of a corporate agent:1. The Authority shall issue a Show Cause Notice to the corporate agent, requiring them to show cause within 21 days from the date of receipt of the notice, why the registration granted to the corporate agent shall not be suspended or cancelled or any other action as considered appropriate by the Authority for the violations noted in the show cause notice shall not be taken.
2. The corporate agent shall submit its reply to show cause notice issued by the Authority within the time limit stipulated in the notice.
3. Upon considering the reply, if any, the Authority may pass an order directing the suspension or cancellation of the registration granted to the corporate agent or shall pass any other order as deemed appropriate based on the facts of the case.
4. The Authority shall communicate the decision to the corporate agent within thirty days from the date of taking such decision stating therein the grounds on which the decision is taken.
5. Any applicant aggrieved by the decision of the Authority may make an appeal to Securities Appellate Tribunal, as per the procedure prescribed for such an appeal, within a period of forty-five days from the date on which a copy of the order made under clause (4) above is received by him, for passing such orders thereon as it thinks fit, conforming, modifying or setting aside the order appealed against,
III. Cancellation of Certificate or Registration of a corporate agent without noticeThe Registration of a corporate agent may be cancelled or suspended without notice, provided the Authority has communicated to the corporate agent the reasons for the cancellation in writing:(i)if it is found guilty of fraud, or is convicted of a criminal offence;(ii)commits such defaults, which require immediate action in the opinion of the Authority;The procedure to be followed while initiation of Action against the corporate agent under this regulation is as specified in clauses (4) and (5) of Part II above.IV. Effect of Suspension or cancellation of Certificate of Registration to corporate agent(i)Any corporate agent whose registration has been suspended or cancelled by the Authority, shall, on and from the date of the receipt of the communication under these Regulations, shall cease to act as a corporate agent and shall cease to solicit Insurance business,(ii)On and from the date of suspension or cancellation of the registration, the corporate agent shall:(a)not undertake any new assignment or contract related to insurance business or solicit or procure insurance business during the period of such debarment or suspension;(b)take such other action including the action relating to any records or documents and policies or money of the policyholders as per the directions of the Authority and relevant provisions of these regulations.(c)return the registration to the Authority and shall not represent itself to be a holder of registration for carrying out the activity for which such registration had been granted;(d)make provisions as regards liability incurred or assumed by it;(e)take such other action including the action relating to recovery or seizure of any records or documents and policies of the policyholders that may be in custody or control of such person, within the time period and in the manner, as may be required under the relevant regulations or as may be directed by the Authority while passing order under this Chapter or otherwise.
VIA
[See regulation 31]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Certificate to be submitted by the insurer duly signed by CEO and CFO of the company on the remuneration and other payments made to a Corporate Agent"We hereby and confirm that we have paid an amount of Rs .................to M/s ................................... (name of the Corporate Agent and associates) for the period from ................ to...............under following heads (to be annexed as an attachment) as commission/remuneration towards the business of ____________procured during the FY___. The amount includes all payments paid directly or indirectly to this effect and the company (insurer) is in compliance with the regulations prescribed by IRDAI, RBI and other applicable regulations to this effect.We also confirm that we have not paid incentives (cash or non-cash) to the principal officer, specified persons and other employees of the corporate agent either directly or indirectly."Signed byCFO CEOPlace:Date:Note. - (1) The attachment shall contain the details of payments made to the corporate agent and its associates (specify the name of the associate) under various heads and shall be signed by both the CEO and CFO of the insurer.(2)Separate certificates to be submitted for each corporate agent
VIB
[See regulation 31]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Certificate to he submitted by the corporate agent duly signed by CEO and CFO of the company/entity on the remuneration and other payments received from the insurer"We hereby and confirm that we have paid an amount of Rs .................to M/s ................................... (name of the Corporate Agent and associates) for the period from ................ to...............under following heads (to be annexed as an attachment) as commission/remuneration towards the business of___________procured during the FY________. The amount includes all payments received directly or indirectly to this effect and the company (corporate agent) is in compliance with the regulations prescribed by IRDAI, RBI and other applicable regulations to this effect.We also confirm that the insurer has not paid incentives (cash or non-cash) to the principal officer, specified persons and other employees of the corporate agent cither directly or indirectly."Signed byCFO CEOPlace:Date:Note. - (1) Hie attachment shall contain the details of payments made to the corporate agent and its associates (specify the name of the associate) under various heads and shall be signed by both the CEO and CFO of the corporate agent.(2)Separate certificates to be submitted for each insurer.
VII
[See regulation 25]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015I. Instructions for Sale of Insurance products by tele-marketing mode and other distance marketing activities of corporate agent.1. Scope and applicability. - This covers distance marketing activities of corporate agents at all the stages including offer, negotiation as well as conclusion of sale.
(a)Distance marketing includes every activity of solicitation and sale of insurance products through the following modes:(i)Voice mode, which includes telephone-calling;(ii)Short Messaging service (SMS);(iii)Electronic mode which includes e-mail, internet and interactive television (DTH);(iv)Physical mode which includes direct postal mail and newspaper & magazine inserts; and,(v)Solicitation through any means as approved by the Authority from time to time under Distance Marketing.(b)These instructions are specifically applicable in case of the following activities in addition to other similar activities:(i)Use of distance mode for ascertaining the Prospect's intent to purchase insurance.(ii)Solicitation as well as sale over the distance mode; and(iii)Requests by Prospects seeking information or sale of insurance products.2. Compliance. - The corporate agent shall, in addition to these instructions, comply with all the applicable provisions of the Insurance Act, 1938, the IRDA Act, 1999, IT Act, 2000, TRAI Act, 1997, The Telecom Unsolicited Commercial Communications (Amendment) Regulations. 2008 and the rules, regulations, circulars or guidelines, as applicable to it, issued from time to time.
3. Persons engaged for solicitation. - (a) For the purpose of solicitation of insurance business through distance marketing, the corporate agent may engage:
(i)Specified persons of corporate agents, or(ii)Authorised Verifiers of Telemarketers(b)The corporate agent shall be responsible for all acts of commission and omission of the persons deployed on their behalf.4. Agreements between the corporate agent and Telemarketers. - The agreement between the corporate agent and Telemarketer, by whatever name called, shall inleralia include the following clauses:
(i)The Telemarketer shall maintain/preserve recordings of all the calls in a manner that is compliant with the provisions of these instructions and forward all such records to the corporate agent. The corporate agent in tum shall forward a copy of the records to the insurer in satisfactory condition.(ii)The Telemarketer shall maintain records of all the authorized Verifiers employed by them along with their training and assessment particulars, including the certificate issued by the Authority.(iii)The records under (i) & (ii) above shall be open to inspection by the Authority.5. Role of Authorized Verifier. - (i) Telemarketers shall employ authorized Verifiers, who alone are permitted for soliciting and concluding] the sale of insurance products;
(ii)The authorized Verifiers shall be employees of the Telemarketer and they shall be assigned to the corporate agent as per the certificate issued by the Authority for the purpose of sale of insurance products Any change in such assignment shall be disclosed to the Authority and a fresh certificate to that effec shall be obtained from the Authority without which the Authorised Verifier shall not be permitted t< solicit and conclude the sale of insurance products;(iii)Authorized Verifiers are barred from soliciting insurance in their individual capacity in any mode, or o behalf of any organization other than the Telemarketer employing them.(iv)the corporate agent shall maintain records in the format specified by the Authority which shall capture policy-wise and Authorised Verifier-wise details wherein each policy solicited by the corporate agent through the distant mode is tagged to the authorized Verifier. The corporate agent shall put in place systems which allow regular access to such records and details by the Authority.6. Conduct in relation to sale of insurance products through distance marketing by corporate agents. - (i) Corporate Agent shall suggest a suitable product, from among the insurance products of insurer/ which they have arrangements as per these regulations, available in the market that Fits the needs Prospect.
(ii)The price comparison charts that are displayed on their website shall be uP to date and reflect a true picture of all the available and suitable Products under each category.(iii)Insurers shall specifically identify the proposals procured by corpo.ate agents over distance mode and obtain all relevant records pertaining to such policies Insurers shall produce such records before the Authority in case of dispute involving alleged violation of breach of conduct by the corporate agent.7. Process of Solicitation. - Solicitation of insurance by corporate agents through distance mode shall be in specific compliance with the following norms:
7.1Standardized Script. - (i) Insurers, in consultation with the Corporate Agents, shall prepare standardized scripts for presentation of benefits, features and disclosures under each of the products proposed to be sold over the distance modes. Solicitation under distant mode shall be in line with the standardized script,(ii)The scripts shall be incorporating all the Key Features of the product and shall be approved by the compliance officers of the respective insurers. The scripts shall be filed with the Authority under "Use & File" procedure within 15 days of their approval by the compliance officer.7.2Introduction. - (i) The communication shall clearly highlight the name of the corporate agent and names of insurers with which they have arrangements to distribute insurance products.(ii)Hie fact that the purpose of approach is solicitation of insurance shall be clearly highlighted.7.3Consent of the Prospect. - (i)The authorized Verifier shall proceed further only on receiving the consent of the prospect in explicit terms.(ii)The prospect shall be given an option to continue with the subject or exit the page at every stage in case of electronic modes. The hours during which calls are made shall be in accordance with orders issued by TRAI/DoT from time to time.(iii)In case of telephonic solicitation the name of the authorized Verifier along with the certificate number issued by the authority shall be disclosed and the language options available must be indicated. The subsequent communication shall continue only in the language chosen by the Prospect.(iv)The authorized Verifier shall inform Prospects that the call is being recorded and that the Prospect is entitled to a voice copy, if he so desires, at any time during the term of the policy or until a satisfactory settlement of claim, whichever is laier.(v)No inconvenience, nuisance or harm shall be caused to the Prospects in the course of solicitation or thereafter. Full disclosures shall be made to the Prospects under all modes of distance marketing and the requirements of confidentiality, privacy and non-disclosure shall be complied with.7.4Prospects Information. - All relevant information pertaining to the Prospect as well as the person/asset to be insured shall be obtained, and solicitation shall be strictly on the basis of analysis of the Prospects' needs, as specified by the Authority from time to time.7.5Product benefits & Features. - The standardized script shall cover the following items in the course of product presentation:(i)The specific responses of the Prospect in the form of agree/disagree, yes/no, accept/reject, understand/don't understand, as applicable, against each of the items below, should cover under all modes of distance solicitation.(ii)Name of the product suggested and its nature and parameters.(iii)Insurance cover available under the product for a specified amount of annual premium, or, conversely, premium chargeable towards a specified amount of insurance cover.(iv)The scope of cover, perils covered and not covered, exclusions, deductibles or franchise, co-payments, loading/discounts on premiums, add-on covers, conditions, other terms and benefits, mid-term inclusions, short period scales, basis of sum insured, warranties, clauses and endorsements, compliance with Section 64VB of the Insurance Act, 1938 - payment of premium before commencement of risk, etc, as applicable.(v)The contents of the key features document as and when specified by the Authority.(vi)The right to cancel the policy within 30 days of receipt of the policy in case of disagreement with the terms of the policy under all life insurance contracts and covers tied to credit/debit/other cards, and for all personal accident and health insurance policy contracts with a term of 3 years or more offered by insurers over distance mode, provided no claim has already been made on the policy.(vii)Disclosure of rates of commission available on the product solicited upon the request of the Prospect.7.6Premium Ceilings in case of sale of ULIPs and prohibition of sale of Universal Life Products over telephonic mode. - (i) Corporate agents shall not solicit ULIPs of non-single premium type for annualized premiums exceeding Rs 50,000/- over telephonic mode (voice as well as SMS).(ii)Single premium ULIPs shall hot be solicited for a premium of more than Rs 1,00,000/- over telephonic mode.(iii)No variable insurance product shall be solicited or sold over distance marketing mode.8. Post-Solicitation Process. - Once the Prospect agrees to purchase a policy, the proposal form and premium acceptance shall comply with the following requirements:
(i)The premium towards the policy may be debited online or interactive voice response medium or through a manual collection subject to compliance with the procedures and controls prescribed by the RBI.(ii)The norms applicable to insurers and intermediaries as regards AML and PAN need to be complied with in the process of selling a policy over distance marketing mode.(iii)For policies solicited/sold over distance mode, insurers shall issue policies in exactly the same format and medium as in case of sate through physical interface, duly enclosed by the requisite annexures.(iv)The address and toll-free number of the office to be contacted by the policyholder in case of a servicing need or grievance shall be informed to the Prospect.(v)Before conclusion of sale the authorized Verifier shall divulge his name and certificate number to (he prospect and this shall form part of the recorded conversation for the sake of future verification.(vi)The records pertaining to every call made and SMS sent by a Telemarketer/Corporate Agent that materializes into a policy shall be transferred to the insurer's location within 30 days of conclusion of sale. In case of telephone calls the records transferred shall be the recordings of the entire conversation.9. No Unfair Denial of Insurance Cover. - When a Prospect approaches a corporate agent over distance mode proposing for insurance cover, the latter are duty-bound to consider the case on merits and in accordance with regulatory directions and their own norms. In no case shall they resort to an unfair denial of cover to a Prospect who seeks insurance.
10. Preservation of Records. - The corporate agent shall preserve, in an inalterable and easily retrievable form, a voice/electronic/physical record, as applicable, of the entire process beginning with lead generation/solicitation and concluding in sale of insurance, for a period of six months beyond the term of the policy or until satisfactory settlement of claim, whichever is later. Voice and electronic records shall be digitlized and encrypted for storage to ensure reliability and security of the data.
11. Verification Process. - (i) Corporate agents shall monitor the calls live by arranging for listening to at least 1% of the calls as they happen.
(ii)Corporate agents shall verify at least 3% of calls leading to sales for compliance with the instructions, by engaging a team of dedicated employees to listen to the call recordings. The observations made in the course of verification shall be preserved in a retrievable form for a period of not less than three years.(iii)Corporate agent shall make verification calls, to monitor the quality of sales, to a minimum of 3% of the policyholders who purchase insurance over distance marketing mode, every month. The purpose of verification calls is to ascertain whether the Prospect has understood the benefits, features and disclosures of the product purchased correctly. Verification calls shall also bear a standardized script and the records of calls shall be preserved for a period (a) not less than 15 months from the date of policy or until satisfactory claim settlement, whichever is later, in case of non-life contracts (b) not less than 3 years in case of life insurance policies.(iv)The policies under (ii) and (iii) above shall be selected according to a random pattern, making sure to cover each product category and mode of sale.12. Certification of Compliance. - The Principal Officer of each corporate agent shall submit to the Authority, at the end of each financial year, a certificate confirming that the corporate agent has complied with all the provisions of the above instructions (para- 7 to 11) during the financial year.
13. Disputes. - or the purpose of these instructions the contract of insurance shall be deemed to include the contents of Key Features Document (KFD) and the records of calls to the Prospect pertaining to the product. In case of disputes involving specific wordings of the policy, the Prospect shall have the right to give primacy to the wordings of the KFD and the calls over the specific wordings of the policy.
VIII
[See regulation 21]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Certificate to be submitted by the corporate agent duly signed by CEO and CFO of the company/entity on forced selling"We hereby confirm that the insurance is sold as an ancillary product along with a principal business product. None of the employees of the corporate agent or our shareholders or our associates have compelled the buyer of the principal business product to necessarily buy the.insurance product through us. We also certify that we have not forced any prospect io buy insurance through us only.Signed by
Annexing 3[See regulation 7(3)(c)]Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Application for a Certificate/Renewal of Certificate to act as a Specified PersonNotes and Instructions:1. An application for issue of certificate/renewal of certificate to act as a Specified Person shall be applied by the Principal Officer of the Corporate Agent, on behalf of the Specified Person, giving the details of such person as per the details below.
2. The Principal Officer and the corporate agent shall be responsible for any omission and commission of information provided on behalf of the Specified Person.
3. An individual can apply for only a certificate which will entitle him to solicit or procure insurance business of any class and to act as the specified person of a corporate agent.
4. A person aspiring to be a Specified Person must be at least 18 years of age on the date of the application. If required the applicant shall furnish proof of age.
5. An applicant shall furnish the proof of educational qualification; pass in the pre-recruitment test conducted by the examination body nominated by Insurance Regulatory and Development Authority of India, and completion of practical training from a training institution approved by the Insurance Regulatory Mid Development Authority of India, along with the application.
6. The fees payable by ah applicant is rupees five hundred or an amount specified by the Authority from time to time.
7. An application for renewal should reach the Authority through the corporate agent before the expiry of certificate of the specified person but not before three months from the date of expiry.
8. If the application does not reach the Authority at least 30 days before the date on which the certificate ceases to be in force, an additional fee of one hundred rupees should be payable.
______________________________________________________________________________________________________________________1. Name of Person seeking Certificate to act as Specified Person; _____________________________________________ (As mentioned in the Passport or Birth Certificate)
2. Father's/Husband's Name;_____________________________________________
3. Full Address along with Contact Number:_________________________________________________
4. Date of Birth: Day-Month-Year:__________________________________________
6. PAN Number/Adhaar Number:__________________________________
7. Whether already enrolled as a Specified Person:
(i)If yes, please submit the following.(a)Name of the Corporate Agent:_______________;_______________(b)Registration/License Number of the Corporate Agent:________________________________________(c)Date of Expiry of Registration:______________________(d)Certificate No of the Specified Person issued by the Authority:_________________(e)Specified Person Examination Pass Certificate No.____________________(f)Name of the Institution where training undergone______________________(g)Number of training hours competed___________________(h)Name of the corporate agent with whom last employed_____________________(i)Registration/licence number of the corporate agent as indicated in (h) above___________________(ii)If no, please submit the following.(a)Name of the Corporate Agent/Applicant Company: _____________(b)In case of existing Corporate Agent, Registration/License Number of the Corporate Agent/Applicant Company:____________________(c)Date of Expiry of Registration/license;_________________(d)Specified Person Examination Pass Certificate No._____________________(e)Name of the Institution where training undergone;____________________(f)Number of training hours completed_________(g)Date of completion of training_____________________I further declare that I have verified and found that the Specified Person -(a)has not found to be of unsound mind by a court of competent jurisdiction;(b)has not been found guilty of criminal misappropriation or criminal breach of trust or cheating or forgery or an abetment of or attempt to commit any such offence by a court of competent jurisdiction;(c)has not been found guilty of or to have knowingly participated in or convicted at any fraud, dishonesty 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 an investigation of the affairs of an insurer; and(d)has not violated the code of conduct specified under Regulation 26 of Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015.8. I enclose the following documents in support of the educational qualification, pre-recruitment test, and the practical training undergone by the specified person.
(d)Signature of the Principal OfficerPlace:Date:Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Certificate to act as a Specified Person for a Corporate AgentCertificate No................................Name of Corporate Agent:.............Address:.....................................................................Registration No......................Date of Expiry:......................Category of Registration:......................Name of the Certificate Holder:......................Address:.................................................................Details of branch where posted:...................Having undergone the prescribed training and passing of the examination is hereby authorized to act as the specified person of the above named corporate agent for three years from...................... for procuring or soliciting insurance business in the category of............
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Notes. - 1. This certificate authorizes the certificate holder to act as the specified person of the corporate agent for the insurance business specified there under.2. No correction in this certificate is valid and for any correction in the certificate, the specified person through the principal officer of the corporate agent shall make a request to the Authority for the same.
3. The attention of the certificate holder is drawn to the code of conduct specified under regulation 26 of Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015, and any violation of code of conduct may result in cancellation of certificate.
Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Form B[See regulations 4 & 9]Certificate of RegistrationRegistration No:1. In exercise of the powers conferred by sub-section (1) of Section 42D of the Insurance Act, 1938 (4 of 1938) the Authority hereby grants a certificate of registration to
________________________________________________________________________________to act as______________________________________________________________________________corporate agent(Mention details of category)under that Act.2. Registration Code for the corporate agent is
_________________________________________________________3. This registration shall be valid from_______________________to_______________________
4. This registration is subject to the Act, Insurance Regulatory and Development Authority Act, 1999 (4 of 1999) and Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015 and shall not be construed to be in compliance with or in conformity to any other Act, rules or regulations.
Date:_______________For and on behalf of Insurance Regulatory and Development Authority of IndiaInsurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Form C[see regulation 11}Certificate of Renewal RegistrationRegistration No:1. The Registration of M/S ..................................................Category................corporate agent is hereby renewed under Regulation 11 of the IRDAI (Registration of Corporate Agents) Regulations, 2015, and the Insurance Regulatory and authority Act, l999 ( 4 of 1999) for the period ...............to...............
2. Issued at Hyderabad on....................day of..............Two thousand.............
3. This registration is issued subject to the condition that the applicant shall comply with all the provisions of the Insurance Act, 1938, Insurance Regulatory and Development Authority Act, 1999 (4 of 1999), Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015 the, Rules or regulations made thereunder and the Guidelines, Circulars,& Directions issued by the Authority from time to time.
Place:By OrderDate _____________For and on behalf of Insurance Regulatory and Development Authority of IndiaInsurance Regulatory and Development Authority of India(Registration of Corporate Agents) Regulations, 2015Form B[See regulation 15 ]Duplicate Certificate RegistrationRegistration No:1. In exercise of the powers conferred by sub-section (1) of section 42D of the Insurance Act, 1938 (4 of 1938) the Authority hereby grants a certificate of registration to
______________________________________________________________to act as___________________________________________________________ corporate agent(Mention details of category)under that Act.2. Registration Code for the corporate agent is
_______________________________________________3. This registration shall be valid from___________________________to.
4. This registration is subject to the Insurance Act, 1938, Insurance Regulatory and Development Authority Act, 1999 (4 of 1999) and Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015 and shall not be construed to be in compliance with or in conformity to any other Act, rules or regulations.
Place:By OrderDate: ________________________For and on behalf of Insurance Regulatory and Development Authority of IndiaInsurance Regulatory and Development Authority of IndiaApplication for Duplicate Certificate of Registration1. I agree to inform you that my/our Registration No..................................has been
3. Mutilated
Due to the following reasons.............................................2. Fee payment: .
A non-refundable fee of Rs. 1000/- will need to be paid to IRDAPayment details:Name of the Bank:Mode of payment: NEFT/RTGSDate of Payment:Transaction Details along with number:3. Declaration
I hereby apply for the duplicate certificate of registration under regulation 15I/we therefore request the authority to kindly issue a duplicate certificate of registration in light of the circumstances explained above.I ................................solemnly declare and confirm that the particulars given above are true to the best of my knowledge and belief.Signature of Director 1Signature of Director 2Date:Annexure 4[See regulation 25}Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Application for Permission to act as TelemarketerParticulars of the Applicant1.1Name of the Applicant: _____________________________1.2Address - Principal Place of business/Registered Office.
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1.4TRAl Registration Details(c)Validity of Registration:1.5Name and Designation of the Authorised Person/In charge:1.6Details of proposed/existing branch office/s where the applicant proposes to conduct telemarketing
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Educational Qualification of the SpecifiedPerson
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1.7Name of the corporate agent with whom the applicant intend to work with:2. Organisation - Structure
2.1Status of the Applicant:(e.g. Limited company-Private/Public, LLP/ Cooperative Society/Partnership Firm/Proprietary Firm. If listed, names of Stock Exchanges and latest share price to be given)
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Date of IncorporationDD-MM-YYYY
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Name of stock exchanges(In case of listedCompany)
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2.2List of major shareholders (holding 5% and above of applicant directly or along with associates)
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2.3Particulars of all Directors/Partners
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Name and activities of associate companies/concerns
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Nature of lnterest of Promoter/ Director |
Nature and interest of applicant company |
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Whether any one or more directors/shareholders of the associate companies/ concern are interested in the applicant's business, if yes please provide the nature of interest2.4Details of Telemarketing Activities with other entities
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Whether any of the related parties of the entitydeal with insurance. If yes, please specify the details
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Details of Authorised Verifiers
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PAN/ Adhar No. |
Qualification (Including Insurancequalifications)
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Details of Responsibilities |
Exam pass Certificate issued by Examination Bodyas per Regulations
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(Note. - The Telemarketer shall update the addition/deletion of Authorised Verifiers from to time to time and as and when there is change)3. Other Information, If Any
3.1Details of all settled and pending disputes**:
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** Attach sheet if requiredDetails, if any of any economic offences by the applicant or any of the Directors and/or any disciplinary action taken/initiated by any other regulator or government authorities in the last three years.4. I further declare that I have verified and found that the applicant -
(a)has not found to be of unsound mind by a court of competent jurisdiction;(b)has not been found guilty of criminal misappropriation or criminal breach of trust or cheating or forgery or an abetment of or attempt to commit any such offence by a court of competent jurisdiction;(c)has not been found guilty of or to have knowingly participated in or convicted at any fraud, dishonesty 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 an investigation of the affairs of an insurer: and(d)has not violated the code of conduct specified under Regulation 26 of Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015.5. I enclose the following documents in support of the application.
(a)Copy of TRAI RegistrationSignature of the Authorised PersonPlace:Date:Insurance Regulatory and Development Authority of India (Registration of Corporate Agents) Regulations, 2015Certificate to act as a Telemarketer for a Corporate AgentCertificate No................................Name of Corporate Agent:...............Address:..................................................................................Registration No........................Date of Expiry:........................Category of Registration:..................Name of the Certificate Holder:...............................................................Address:..............................................................TRAI Registration No.:.....................Having satisfied with the information furnished is hereby authorized to act as the telemarketer of the above named corporate agent as per IRDAI(Registration of Corporate Agents) Regulations, 2015.Place:Date:For Insurance Regulatory and Development Authority of IndiaDate of Expiry:Name of the Certificate Holder:.......................................Address:..........................Place of posting:Having satisfied with the information provided and undergone the prescribed training arid/or passing of the examination is hereby authorized to act as an authorized Verifier of the telemarketer from....................Place:Date:For Insurance Regulatory and Development Authority of IndiaSignature of the Certificate Holder: