Irda Forms - Ia / Ib / Ic
Irda Forms - Ia / Ib / Ic
Irda Forms - Ia / Ib / Ic
KYC
To,
Name of the Insurer S B I G E N E R A L I N S U R A N C E
Please paste self attested
C O M P A N Y L I M I T E D passport size
coloured photograph
Dear Sirs,
I request that Appointment to act as an insurance agent of your organisation may be granted to me.
I hereby declare that particulars given below are true and that the APPOINTMENT for which I apply will
be used only by myself for soliciting or procuring insurance business for your Insurance Organisation.
PERSONAL INFORMATION
1) Name F I R S T N A M E M I D D L E N A M E S U R N A M E
3) Father's / F I R S T N A M E M I D D L E N A M E S U R N A M E
Husband's Name
4) Full Address
Pin Code
E-mail ID
7) PAN CARD Number (Please attach self-attested copy of the PAN CARD)
8) Particulars of pass in pre-recruitment test conducted by the Insurance Institute of India or any Examination Body:
Name of Examination Body:
Candidate's Name:
Candidate's Number:
Centre of Examination
Name of the Exam passed
Date of Passing D D M M Y Y Y Y
9) I declare that
a) I have not been found to be of unsound mind by a court of competent jurisdiction;
b) I have 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) I have not been found guilty of or to have knowingly participated in or connived at any fraud, dishonestly or mis-representation
against an insurer or an insured.
d) I have not violated the Code of Conduct specified under Clause 7 of the IRDAI (Appointment of Insurance agents)
Guidelines, 2015.
Place: Date: D D M M Y Y Y Y
Signature of Applicant
NOTES AND INSTRUCTIONS
a) The application should be filled in, as far as possible, in Hindi language or English language.
b) Any correction or alteration made in any answer to the questions in the application should be initialled by the applicant.
c) An applicant must be at least 18 years of age on the date of the application. If required the applicant shall furnish proof of age.
Version 1.0, Apr 2015
d) An applicant shall furnish the proof of pass in the Insurance examination conducted by the Insurance Institute of India, Mumbai or an examination body
approved by the Insurance Regulatory and Development Authority of India, along with the application.
e) The following documents should be attached with the application (a) Age Proof (b) Educational Qualifications (c) Proof of pass in the agency examination
as mentioned above (d) Copy of PAN Card (e) Address proof to the satisfaction of the insurer (I) Cessation Certificate if any, that IS held by the Agent
NOTE TO THE INSURER
1. The applicant should be provided with an acknowledgment for the receipt of the Agency Application form
2. The details in the application form should be verified with the data available with the insurer and the application form with due authentication should be forwarded to the
insurer with whom the applicant is seeking Agency within 15 days of the receipt of the application form from the applicant. A copy of the forwarding letter should be sent
to the applicant for his records.
3. The designated official of the Insurer should ensure that under no circumstances, there is a delay in forwarding the application form to the concerned insurer.
4. The applicant shall ascertain from the Insurer to whom he has submitted the Agency Application form on the status of the Agency application submitted by him.
FORM I-B
APPLICATION OF AN EXISTING INSURANCE AGENT FOR APPOINTMENT
TO ACT AS COMPOSITE INSURANCE AGENT WITH ANOTHER INSURER
(LIFE OR GENREAL OR HEALTH INSURANCE or MONO-LINE INSURANCE)
Name of the Insurer Agency code Number Date of Appointment Date of cessation of Reason for cessa1ion of agency
as agent Agency
Note If Agency is currently in-force with an Insurer mention "INFORCE" in the column Date of cessation of Agency
Life Insurer
General Insurer
Health Insurer
Other Mono-Line Insurer
** Mention name of the Insurer in the Box above
Note
i) No person shall act as an insurance agent for more than one life insurer, one general insurer, one health insurer and one of each of other mono-line insurers
ii) Any person who acts as an insurance agent in contravention of the provisions of this Act, shall be liable to a penalty which may extend to ten thousand
rupees
iii) Attach Separate Application Form for each of the Insurance Organisation with whom you seek to obtain Appointment and submit all the Application Form
to your current insurer only.
(As appearing in S U R N A M E M I D D L E N A M E F I R S T N A M E
supporting documents )
S U R N A M E M I D D L E N A M E F I R S T N A M E
Father's Name
ADDRESS DETAILS
Town District
Telephone No.
Proof of address to be provided by Applicant. Please submit ANY ONE of the following valid documents & tick (a
) against the document attached.
Latest Telephone Bill Latest Electricity Bill Passport Driving License Latest Bank Passbook Latest Bank Account Statement
Latest Demat Account statement Voter Identity Card Ration Card Registered Lease / Sale Agreement of Residence
OTHER DETAILS
Upto Rs. 5,00,000 Rs. 5,00,001 to Rs. 25,00,000 Rs. 25,00,001 to Rs. 1,00,00,000 Rs. 1,00,00,001 to Rs. 5,00,00,000
Private Sector Service Public Sector / Government Service Business Professional Agriculturist Retired
Declaration
I hereby confirm that I have read and understand the terms and conditions. I agree to abide by terms and condition, rules and regulation and any other
statutory requirements applicable. I hereby agree to provide any additional information / documentation that may be required.
Version 1.0, Apr 2015
Place:
D D M M Y Y Y Y Signature of Applicant
Date:
Corporate & Registered Office: ‘Natraj’, 101, 201 & 301, Junction of Western Express Highway & Andheri - Kurla Road, Andheri (East), Mumbai 400069
Insurance is the subject matter of the solicitation. | SBI Logo displayed belongs to State Bank of India and used by SBI General Insurance Co. Ltd. under license.
NEFT / EFT MANDATE FORM
Date :
To,
SBI General Insurance Company Ltd.
101-201-301, Natraj Building,
Junction of Western Express Highway,
Andheri Kurla Road,
Andheri (East).
Mumbai 400069
I request you to kindly credit commission amount directly to my account as per the bank
details given below.
Agent Name :
IRDA License No :
Bank Name :
Bank Account No :
IFSC Code :
Thanking You,
-----------------------------------
(Agent Name & Signature)
Version 1.0, Apr 2015
SBI GENERAL INSURANCE COMPANY LIMITED
GENERAL TERMS AND CONDITIONS & CODE OF CONDUCT APPLICABLE TO AGENT OF THE
COMPANY.
These terms and conditions apply to and regulate the viii. “Insurance Product” means any plan of
rights and obligations of the Insurance Agent (as insurance, which is offered by SBI General
defined herein below). These terms and conditions Insurance Company Limited.
shall be in addition to terms prescribed in IRDA ix. “Confidential Information” means, in
Guidelines / Regulations and any other terms as relation to the Company and its
stipulated by SBI General Insurance Company policyholders, information which is not
Limited. publically known but which relates to the
company’s policyholders, employees,
1. DEFINITIONS: Insurance Agents, products, operations,
trade secrets, copy rights and similar rights
Unless the context otherwise requires etc. “IRDA Act” means the Insurance
Regulatory and Development Authority Act,
i. “Act” means the Insurance Act, 1938 and 1999(41 of 1999) including modifications,
includes any amendment thereto or amendments or re enactments thereof, as in
enactment thereunder ; force from time to time.
ii. “Applicable Law” means one or more x. “IRDA Regulations” means the regulations
provisions of the Act, the insurance Rules, made by the IRDA in exercise of its powers
the IRDA Act and the IRDA Regulations under the Act and the IRDA Act including
including modifications, amendments or re- modifications, amendments or re-enactments
enactments thereof, and the guidelines, thereof, as in force from time to time.
directives ,notifications and orders issued by xi. “Terms” refer to terms and conditions herein
the IRDA as in force from time to time. in connection with the appointment of the
iii. “Applicant” means a person who has applied Insurance Agent.
to SBI General Insurance Company Limited
for being appointed as an Insurance Agent. 2. CODE OF CONDUCT:
iv. “SBI General Insurance Company Limited”
refers to SBI General Insurance Company Every person who is appointed as Insurance Agent
Limited having its registered office at its by the Company shall adhere to the model code of
Corporate and Registered office at "Natraj", conduct as specified below:-
101, 201 & 301, Junction of Andheri-Kurla
Road & Western Express Highway, Andheri I. THE INSURANCE AGENT SHALL,
(East), Mumbai - 400 069 (a) identify himself/herself and SBI General
v. “Insurance Agent” means the Applicant who Insurance Company Limited, of whom
is appointed as an insurance agent of SBI he is an insurance agent to all the
General Insurance Company Limited And prospects;
designated as a Insurance Advisor. (b) At all times show the agency identity
vi. “Authority” or the “IRDA” means the card to the prospect, and disclose
Insurance Regulatory and Development Agency Appointment Letter to the
Authority constituted under section 3 of the prospect on demand ;
IRDA Act 1999; (c) disseminate the requisite information in
vii. “Company” means SBI General Insurance respect of insurance products offered for
Company Limited; sale by company and take into account
the needs of the prospect while
recommending a specific insurance (l) The Insurance Agent is not authorized
plan; and shall not be entitled anytime to
(d) disclose the scales of commission in collect premium from the
respect of the insurance product offered policyholders in cash and shall be
for sale, if asked by the prospect; under obligation to disclose the prospect
(e) indicate the premium to be charged by / policyholder that the payment towards
the Company for the insurance product premium charges shall be accepted by
offered for sale; the Company by way of crossed cheques
(f) explain to the prospect the nature of or demand drafts only. The Insurance
information required in the Proposal Agent further shall inform and
Form by Company , and also the encourage the policyholder to write
importance of disclosure of material his/her policy number and phone
information in the purchase of an number on the back side of the
insurance contract and shall never instrument paying the premium charges.
persuade or encourage any prospect not
to divulge or disclose any information (m) render necessary assistance to the
which is relevant to the Company for policyholders or claimants or
the purpose of underwriting beneficiaries in complying with the
(g) bring to the notice of the Company requirements for settlement of claims by
every fact about the prospect relevant to the company ;
insurance underwriting, including any
adverse habits or income inconsistency (n) where the Insurance Agent represent
of the prospect, in the form of a report more than one insurer offering same line
(called “Insurance Agent’s Confidential of products (Ex. Health Products), he
Report”) along with every proposal /she should dispassionately advice the
submitted to the Company , and any prospect on the products of all insurers
material fact that may adversely affect whom he/she is representing and the
the underwriting decision of the product best suited to the specific needs
company as regards acceptance of the of the prospect
proposal, by making all reasonable
enquiries about the prospect; (o) The Insurance Agent shall maintain
(h) obtain requisite documents at the time of strict confidentiality of the information
filing the Proposal Form with the received from any prospect and / or the
Company; and other documents Company in the course of business.
subsequently asked for by the Company
for completion of the proposal; (i) The Insurance Agent, shall not use
(i) inform promptly the prospect about the the Confidential Information other
acceptance or rejection of the proposal than for the purposes of its business
by Company ; with the Company, and shall
(j) advise every individual policyholder to disclose it only to its officers,
effect nomination or assignment or directors, or employees with a
change of address or exercise of options, specific need to know. The
as the case may be, and offer necessary Insurance Agent shall not disclose,
assistance in this behalf, wherever publish or otherwise reveal any of
necessary; the Confidential Information
(k) The Insurance Agent may receive received from the Company and/or
Cheques or Demand Drafts in favour of the prospect to any other party
“SBI General Insurance Co Ltd” from whatsoever except with the specific
the policyholders towards payment of prior written authorization of the
premium. However, in such a situation, Company.
he will ensure that the cheques received
are not back dated and the cheque/
The Confidential Information
demand draft are deposited with the
Company within 24 hours of receipt of furnished in tangible form shall not
the same excluding bank holidays.
be duplicated by the Insurance documents submitted to the company
for acceptance of the proposal;
Agent except in the course of
(d) behave in a discourteous manner with
business. Upon the request of the the prospect;
(e) interfere with any proposal introduced
Company, the Insurance Agent shall
by any other insurance agent;
return all Confidential Information (f) offer different rates, advantages, terms
and conditions other than those offered
received in written or tangible form,
by Company ;
including copies, or reproductions (g) demand or receive a share of claim
proceeds from the beneficiary under an
or other media containing such
insurance contract or offer any rebate
Confidential Information, within ten which is prohibited under Section.41 of
the Act.;
(10) days of such request. At the
(h) force , persuade or induce a policyholder
Disclosure’s option, any documents to terminate any existing policy and to
effect a new proposal from him within
or other media developed by the
three years from the date of such
Insurance Agent containing termination of the earlier policy ;
(i) become or remain a director of any
Confidential Information shall be
insurance company;
destroyed by the Insurance Agent. (j) resort to multilevel marketing for
soliciting and procuring insurance
The Insurance Agent shall provide a
policies and/or induct any
written certificate to SBI prospect/policyholder to join a
multilevel marketing scheme.
General/Company regarding
(k) apply for fresh agency appointment to
destruction within ten (10) days act as an insurance agent, if his agency
appointment was earlier cancelled by the
thereafter.
designated official, and a period of five
(ii) The Insurance Agent shall have no years has elapsed from the date of such
obligation under this with respect to cancellation.
Confidential Information which is or
becomes publicly available; is III. THE INSURANCE AGENT SHALL:
rightfully received by the Insurance
Agent without obligations of With a view to conserve the insurance
confidentiality; or is developed by business already procured through him,
the Insurance Agent. 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;
Where the agency contract has been 11. COMPLIANCE WITH ANTI MONEY
terminated for reasons other than fraud, no LAUNDERING NORMS.
commission shall be paid to the terminated
The Insurance Agent shall strictly adhere to the
Agent on renewal premium. However, in
Prevention of Money Laundering Act, 2002,
case a fraud has been perpetrated Rules framed thereon and the Anti Money
by the Agent for sale of Policy, the Laundering (‘AML’) guidelines as prescribed
Commission shall be recovered by by IRDA and any modifications thereto and
employ adequate Know Your Customer
the Company as per procedure as (‘KYC’) standards.
available under the law.
The Insurance Agent shall in accordance with
9. PROHIBITION OF REBATE: the KYC procedures set by the Company shall
ensure the following:
Every agent shall observe and adhere to the • Customer Acceptance Procedures;
provisions of Section 41 of the Insurance • Customer Identification Procedures;
Act, 1938 reproduced hereunder and also • Monitoring of Transactions; and
bring the same to the notice of the prospect: • Risk Management
.
The Insurance Agent shall fully understand the
requirements of the prospect and then suggest
5. Regulation 11(4) - Any breaches of
a suitable product. The Insurance Agent shall
the obligations cast on an insurer or
not induce any prospect into accepting any
insurance agent or insurance
product which the prospect did not need, only
intermediary in terms of these
for the generation of business. In the event of
regulations may enable the Authority to
the prospect rejecting the policy for the reason
initiate action against each or all of
that the product was not what he had required,
them, jointly or severally, under the Act
such sale shall be treated as a miss-sale and
and/or the Insurance Regulatory and
the Company reserves the right to recover the
Development Authority Act, 1999.
cost incurred by the Company on account of
6. Regulation 8(2) : The Insurance
such sale From any amount due and payable to
Agent shall assist the Company and
the Insurance Agent and also charge back the
provide all the required
commission paid to him in respect of such
information/documents from the
Policy.
claimant in case some additional
information/documents are required in
22. TERMINATION OF THE AGENCY:
the process of admissibility of claim or
settlement of the claim.
The Company shall also be entitled at any
time to terminate your agency, without thereby
19. VALIDITY OF LICENCE: being liable for any compensation or damages,
if in its sole opinion,
The appointment as the Insurance Agent is
(a) The performance of the Insurance Agent
subject to your continuing to hold a valid
has not been satisfactory; or
Appointment Letter and Identity Card at all
times. If the appointment is
(b) The Insurance Agent has acted in breach
cancelled/suspended or Insurance Agent wish
of the code of conduct or any of the
to surrender his agency , the appointment as
terms and conditions of appointment; or
Insurance Agent shall stand automatically
terminated with effect from the date of
(c) Any information furnished by the
cancellation or with effect from the date of
Insurance Agent in relation to his
Cessation Certificate issued by Insurer, as the
appointment as such is false; or
case may be.
(d) The Insurance Agent has acted in a
The Insurance Agent understands and agrees
fraudulent manner and continuing him
that once an appointment stand terminated as
as Insurance Agent shall be prejudicial This appointment shall be subject to
to the interest of the Company. jurisdiction of Courts at Mumbai. To signify
his / her acceptance of the terms and
conditions as detailed above, the Applicant
23. TERMINATION is required to sign the original of the Terms
and Conditions and return the same to the
Notwithstanding anything herein before Company.
contained either party may terminate the
agency by giving a notice of one month to 24. DECLARATIONS
the other party without assigning any reason
thereto. The Insurance Agent hereby confirms that
Any notice to be served hereunder shall be he has received a copy of the circular no.
sufficiently served on the Company, if IRDA/CAD/GDL/AGN/016/02/2011(guidel
served by Registered Post at its said ines pertaining to individual Agent) and
Registered Office or any other address as have understood the content and obligations
may be intimated by the Company to the as mentioned in the guidelines.
Insurance Agent in writing, and shall be
deemed to have been sufficiently served on
the Insurance Agent if sent to him by
Registered Post at his address last noted in
his records by the Company. Signature :
IN WITNESS WHEREOF:
Signature of Agent:
Witness
1)