REPORT OF THE DEVELOPMENT OFFICER
1)
(a) Is the applicant related to
(i) Yourself?
(ii) Any other employee of the Corporation?
(iii) Medical Examiner?
(iv) Any existing or ex-agent of the Corporation with in the area of the Division (Write “yes” or “No”)
(b) If the answer to any of the question under is “Yes”, please give following further information about the person to whom the applicant is related.
(a) Name:Designation :
(b) Territory:Relationship :
(c) Is the applicant employed with a Medical Examiner of the Corporation? Yes/No
If “Yes” give details of the Medical Examiner
(d) Whether any other family member is working as Agent with any other Insurer? Yes/No
If “Yes” specify
2)
Are you satisfied that the applicant would be able to absorb the Agency Training and conduct the Agent on his / her own?
3)
(a) Will the applicant work for the Corporation (I)Full time or (ii) Part - time?
(b) If part time, in what other business or activities is he engaged and what is the nature of his duties?
(c) What is his approximate income from other business according to your information?
4)
Place or area in which the applicant will do business
5)
Was he ever in the insurance trade, directly or indirectly?
6)
Source from which application was secured
7)
How long do you know the applicant personally?
8)
Give particulars of apparent bodily defect or deformity
9)
Any other particulars such as education, social background, character, financial stability etc.
I do hereby declare that the foregoing statements and answers have been given after due enquires and are to the best of my knowledge and belief true and complete.
(SIGNATURE OF DEV. OFFICER / CLIA)
Place :
Name :
Date :
Code No.
Preliminare interview by CM / Sr. / Branch Manager
1)
Are you satisfied that the applicant is not related to the Development Officer, any employees of the Corporation., any Medical Examiner and / or another agent or Ex-Agent?
2)
Do you think, in your judgement the applicant would be able to absorb agency training and conduct the agency on his / her own?
3)
Any other remarks / observation
Date :
Signature of the CM / Sr. / Branch Manager
Branch :
Interview by the Appointing Authority on :
Remarks :
Signature of the Appointing Authority
Designated Official
(Marketing Manger)
List of documents submitted (please indicate by 3 Mark) - (For New Agents)
1. Age Proof (Only standard Age Proof to be submitted)
1. Matriculation Certificate
2. Passport
3. Birth Certificate
4. Any other (specify)
2. Qualification Proof
1. Matriculation Certificate No.
2. HSC No.
3. Degree Certificate
4. Any other (specify)
3. Address Proof
1. Aadhar Card
2. Ration Card
3. Voters ID
4. Any other (specify)
4. PAN Card
5. Bank Account Details
1. Cancelled cheque leaf OR
2. First page of Bank pass book / Bank statement
Signature
Details to be submitted by existing Agents
Name :
Agency Code :
Address :
1. Phone No. Land Line with STD Code :
2. Mobile No. :
Do you wish to receive communications through SMS on the above mobile number? Yes/No
3. E - mail ID :
Do you wish to receive communications through e-mail on the above e-mail ID? Yes/No
4. Bank Account Details (Copy of Cancelled cheque leaf / First page of Bank Pass Book to be enclosed)
a) Account Type :
b) Account Number :
c) Bank Name :
d) IFS Code :
e) MICR No. :
5. Aadhar Card (Copy to be enclosed) :
6. PAN Card (Copy to be enclosed) :
I declare that the above information given by me is correct which may be incorporation in your records.
Signature