User Confirmation
Candidate Profile Creation Form
Intermediary type
*
:
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Corporate Agent
Insurance Company
Insurance Broker Authorised Verifiers
Insurance Marketing Firm
Web Aggregators
Point of Sales Person
Insurance Brokers
Applicant Type (Fresh/Renewal)
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:
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Brokers Pre-Licensing Online Training Form(Only Freshers - 50/25 Hours)
Insurance Marketing Firm Online Training Form
User Type
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:
Minimum Educational Qualification(s)
*
Tick Appropriate CheckBoxes
*
Enter Your Qualification :
Qualifications Rules :
1. Are you carrying any Reinsurance related activity?
No
2. Are you an Insurance Consultant for a continuous period of 7 years ?
No
3. Are you a principal underwriter for last 7 years?
No
4. Have you held the position of a Manager in any one of the nationalized insurance companies in India ?
No
No of Hours :
Eligible for :
Hours
Required Hours :
--Select--
25 hrs
50 hrs
Required Hours :
Hours
Fee Amount:
Fee Amount
INR
Declaration:
I am aware of the Qualification and Eligibility Criteria for ISP/Principal Officer of Insurance Marketing Firm and undertake to satisfy the same when I apply for Registration to IRDA.
I am aware of the Qualification and Eligibility Criteria for Brokers Online training of Freshers (50/25) hours and undertake to satisfy the same when I apply for Registration to IRDA.
Corporate type
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:
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Name of Insurance Company
*
:
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GSTIN :
Note - Dear Candidate, if Insurance Broker Company does not exist in the list, please ask your company to create company profile.
Insurance category
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:
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Select Service Provider
*
:
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Subject Language
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:
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Subject
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:
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Hours to be Completed
*
:
Training Type with fee
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:
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In Days Training to be Completed
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:
Applicant Details - Personal Information
Application Date
*
:
Name Initial (Mr/Ms)
*
:
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Mr
Ms
Mrs
Dr
Mx
Applicant Name
*
:
Pan
*
:
Note - Dear Candidate, if your Profile exist in https://www.insuranceinstituteofindia.com/web/guest,
Please search Your profile using the following Screen
Qualification Details
Basic Qualification Details
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:
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Date of Birth
*
:
Sex
*
:
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Male
Female
Others
Nationality Country
*
:
Area
*
:
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Rural
Urban
Do you want to upload Photo and Signature
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Yes
No
Applicant Photo And Sign
Note: Please Upload Image File With Extensions .jpg With Maxmimum Size of 25KB and Dimensions(152 X 133) i.e. (Height X Width)
Applicant Photo
*
:
Applicant Sign
*
:
Contact Information
Is Permanent Address same as Correspondence Address?
Current Address
House Number
*
:
Street/Road
*
:
Town/City
*
:
State Name
*
:
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Andaman and Nicobar Island
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi (NCT)
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
UttaraKhand
Uttar Pradesh
West Bengal
District Name
*
:
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Pin Code
*
:
Permanent Address
House Number
*
:
Street/Road
*
:
Town/City
*
:
State Name
*
:
------Select------
Andaman and Nicobar Island
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi (NCT)
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Ladakh
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
UttaraKhand
Uttar Pradesh
West Bengal
District Name
*
:
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Pin code
*
:
Mobile Number
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:
Email ID
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:
Alternate Email ID
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: