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First Name : Middle Name : Surname :
Father's Name :
Age :  Yrs Date of birth :    
Gender Marital Status :    
Address I Address II   Address III
District City   State
Contact No. Email    
Educational Qualification:    
Occupation :                                   
 
Experience (text box 200 words) :
Would You Like to work as Part Time Agent   Full Time Agent
Are you aware of IRDA training/ test for insurance advisor
  Appear For Online Test   Appear For Offline Test   Not Aware  
Expected Income as an Insurance Agent /PM INR
     
 
Note : Mere submission of details does not entitle the applicant to become Agent/ Corporate Agent or Broker. In order to qualify for this the applicant has to go though IRDA prescribed training/ passing the test.
 
Agent | Corporate Agent | Broker
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