PAN DETAILS

PAN EFDPA2656Q

PERSONAL DETAILS

Area rural

Title Ms.

FirstName CHHAYA SUNIL

LastName AHER

Gender Female

DOB 24/12/2001

Father/Husband First Name SUNIL

Father/Husband Last Name AHER

Maiden Name

Mobile App (Candidate uses) Whatsapp,UPI Apps - GPay/Paytm/PhonePe,Mobile Banking apps

CONTACTS DETAILS

CurrentHouseNo NA

CurrentStreet TAKALI VINCHUR

CurrentTown Takali Vinchur(Niphad)

Residing in current city >10 Years

CurrentLandmark

CurrentLocation
CurrentDistrict Nashik

CurrentState Maharashtra

CurrentPinCode 422306

CurrentContactNo 9890907396

CurrentEmail [email protected]

BANK DETAILS

IFSC BARB0TAKALI

Bank Name BANK OF BARODA

AccountNo 11370100013177

WORK EXP DETAILS

Occupation Housewife

Real estate agent,Education professional (teacher/professor),Sales

Family Occupation
executive,Other salaried employee

Industry Health, Medical, Pharmaceuticals

How many years were you

1-3 Years
in your last job

Please specify the industry

of your previous Education
organization

Does the agent advisor

candidate own an Office Yes - Owned
Space

Will you be engaged in any

No
other occupation

Hours per week you would

Upto 20 Hours
like to dedicate
 EDUCATION DETAILS

Highest Education
Graduate
Qualification

Maharastra State Board of Secondary and Higher Secondary

Board Name
Education

Roll Number S163549

Month & Year Of Passing MAY-2019

Stream Of Education Commerce

TRAINING & EXAM DETAILS

Exam Center NSEIT Limited-Nashik

Exam Language Marathi

EXISTING RELATIVE

Existing RelationShip NO

FirstName

LastName

Go code

RelationShip

Role

Designation

NOMINEE DETAILS

Title Mr

FirstName SUNIL
LastName AHER

Relationship Father

DOB 01/01/1976

Allotment 100 %
 FORM I-A

APPLICATION FOR APPOINTMENT TO ACT AS AN INSURANCE AGENT

(With a Life Insurer OR General Insurer OR Health Insurer)

TO

Max Life Insurance Co. Ltd.

419, Bhai Mohan Singh Nagar,

Railmajra, Tehsil Balachaur,

District Nawanshahr, Punjab – 144533

DEAR SIR,

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

(1) Name: CHHAYA SUNIL AHER

(2) Title: State 1 if Mr., 2 Mrs., 3 Miss : 3

(3) Father's/Husband's Name : SUNIL AHER

(4) Full Address :

House NA
No
Street TAKALI VINCHUR
Town Takali Vinchur(Niphad)
District Nashik
State Maharashtra
Pin 422306
Code
Mobile 9890907396 Email [email protected]
No id

(5) Date of Birth: Day- Month-Year : 24/12/2001

(6) Educational Qualifications : (Tick the right Box) (Attach self-attested certificate)

Class X Class XII Graduate Post Graduate Others

yes

(7) PAN CARD Number : EFDPA2656Q (attach self-attested copy of the PAN CARD)

Guidelines for Appointment of Insurance Agents (Form IA) Page 1 of 3

(8) Particulars of pass in pre-recruitment test conducted by the Insurance Institute of India or any Examination Body:

Name of Examination Insurance Institute of India

Body:
Candidate's Name: CHHAYA SUNILAHER
Candidate's Number: Refer Score Card
Centre of Examination Refer Score Card
Name of the Exam Refer Score Card
passed
Date of Passing Refer Score Card

*In case above details are not available with any applicant who holds a license prior to 01.04.2015, they may
furnish any document evidencing his license and activity as agent with any of the insurer/s.

(9) Furnish the details of any insurance agency in force or ever hold by the applicant:

Name of Agency Date of Date of Reason for

the code Appointment as cessation of cessation of
Insurer Number agent Agency agency

*Please attach Agency cessation letter issued by the insurer

(10)Details of other insurance related activities undertaken, if any:

________________________________________________________________________________________________

(11)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.

Place : Yours faithfully,

Date : Signature of Applicant,

Guidelines for Appointment of Insurance Agents (Form IA) Page 2 of 3

 Notes and Instructions

(1) The application should be filled in Hindi or English language

(2) Any correction or alteration made in any answer to the questions in the application should be initialled by the applicant
(3) An applicant must be at least 18 years and above of age on the date of the application. The applicant shall furnish proof of
age.
(4) An applicant shall furnish the proof of pass in the pre-recruitment exam conducted by an examination body duly recognised
by the Insurance Regulatory and Development Authority of India.
(5) The followingdocuments 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

Guidelines for Appointment of Insurance Agents (Form IA) Page 3 of 3

 Private & Confidential

Terms and Conditions

The terms and conditions contained herein shall form part of the integral part of agreement between the Agent and the Company
Appointment Letter which will be issued to you by the Company, upon and will supersede all prior agreements, understandings
acceptance of your application for appointment as an Insurance Agent whether in writing or oral.
and will govern your appointment as an Insurance Agent with Max
Life Insurance Company Limited ("Company") and will supersede all 4. Appointment:
prior agreements or understandings unless otherwise provided herein. i The Agent acknowledges that the Company will be at liberty to
appoint as many insurance agents as it may deem fit at its
1. Effective Date: These terms and conditions will become effective discretion and acknowledges that the appointment shall be
from the date of appointment and the allotment of the agency code made based on the information submitted to the Company along
stated in the Appointment Letter. with the application form and other representations, warranties,
declarations and undertakings made by the Agent in addition to
2. Definitions: The following terms used in this Annexure shall the representations stated herein. The Agent undertakes to
have the meanings set forth below, unless the context otherwise inform the Company in a timely manner of any material change
requires: in such information, representations and details.
i. “Agency Regulations” means the IRDAI (Appointment of ii. The Agent agrees to solicit and procure insurance business and
Insurance Agents) Regulations, 2016 dated 15th April, 2016 carry out the required related functions of the Agent exclusively
and any regulations issued by the Authority in this regard from for the Company. Notwithstanding anything to the contrary,
time to time; during the Term and subject to Insurance Laws, the Agent
ii. “Agents Handbook” means the compilation of all circulars, agrees and undertakes not to, directly or indirectly, either on his
directions, guidelines, instructions issued by the Company to own behalf or through any other person in any manner
the Agent from time to time during the Term either in writing whatsoever:
or in electronic form or otherwise uploaded on the distribution (a) act as an advisor or consultant or in any capacity
portal to which an Agent has access, and forms an integral part whatsoever for any third person carrying on business that
of the Appointment Letter; directly or indirectly competes with the business of the
iii. “Anti-Money Laundering Policy” means anti-money Company or establish, promote, engage in, carry on,
laundering policy of the Company framed under the Prevention conduct or do any business in India that directly or
of Money Laundering Act, 2002 and rules there under and anti- indirectly competes with the business of the Company;
money laundering guidelines issued by the Authority; (b) be engaged or concerned or interested directly or indirectly
iv. “Authority” means the Insurance Regulatory and in any business in any capacity which is in competition
Development Authority of India; with the business of the Company; and

v. “Insurance Laws” means Insurance Act, 1938, Insurance (c) engage directly or indirectly in the promotion of any
Laws (Amendment) Act, 2015 (the "Act"), the Insurance companies or entities for carrying on any activity
Regulatory and Development Authority of India Act, 1999 (the competing with the activity(ies) of the Company.
"IRDAI Act"), the rules, regulations, guidelines, circulars, 5. Representations and Warranties: The Agent has represented
clarifications or directions issued there under from time to time to the Company that:
including Agency Regulations; and
a. he possesses the minimum qualification as specified under
vi. “Term” means the period from the Effective Date until the the Agency Regulations or such other qualifications as
termination of this appointment as per the terms of this prescribed by the Company and has passed the requisite
Appointment Letter or the provisions of Insurance Laws. insurance examination as specified under the Agency
Regulations and the pass certificate issued by the
3. Interpretation: In this Appointment Letter, unless the context
Examination Body is in force as on the date of the
otherwise requires:
appointment;
i. all words and expressions used and not defined but defined b. he does not suffer from any of the disqualifications
under the Insurance Laws shall have the meanings assigned to specified under the Agency Regulations or Insurance
them in the Insurance Laws; Laws, has the requisite knowledge to solicit and procure
ii. reference to Insurance Laws or any statute, rules, ordinances or insurance business and capable of providing necessary
other laws shall be deemed to include any amendment or services to the policyholders;
modification and references to the masculine gender will c. there are no disputes, litigations, adverse judgments,
include the other genders; and orders, injunctions, claims, prosecutions pending/
iii. references to knowledge, belief or awareness of any person threatened/ passed against the Agent, which may have
shall be deemed to include such knowledge, belief or awareness material adverse effect or impede the performance of the
such person would have if such person had made due and terms of the Terms and Conditions or the appointment
careful inquiries. letter as may issued by the Company;

iv. Notwithstanding anything to the contrary, the Appointment d. he does not hold agency appointment of any other life
Letter, this Annexure, Agents Handbook, all notices and other insurer or is not employed or associated in any capacity
correspondences issued by the Company to the Agent forms an with any life insurance company or any entity that acts as

Appointment Letter (T&C)_Version 1.5_20th June, 2019 1

 Private & Confidential

an insurance intermediary for life insurance business or as c. induce the prospect to submit wrong or incomplete
an insurance marketing firm and his name is not in the information in the proposal form or documents submitted to
centralized list of blacklisted agents; and the Company for acceptance of the proposal;
d. resort to multilevel marketing for soliciting and procuring
e. he has read and understood the relevant Insurance Laws insurance policies and/or induct any prospect/policyholder to
including the Agency Regulations and undertakes to join a Multi-Level Marketing Scheme;
comply with the same at all times. e. behave in a discourteous manner with the prospect;
f. interfere with any proposal introduced by any other insurance
6. Responsibilities: agent;
i. The Agent shall at all times perform its obligations in g. offer different rates, advantages, terms and conditions other
accordance with the highest level of skill and diligence acting than those offered by the Company;
within the authority of the Agent, without making any h. demand or receive a share of proceeds from the beneficiary
misrepresentation, without misconstruing facts, without under an insurance contract;
committing fraud, and in accordance with the highest levels of i. force a policyholder to terminate the existing policy and to
honesty, integrity and good business practice. effect a new policy from him within three years from the date
of such termination of the earlier policy;
ii. The Agent agrees that the Agent shall not engage in conduct j. apply for fresh agency appointment to act as an insurance
which could affect adversely or damage the good standing, agent, if the appointment was cancelled by the Company and
reputation or business interests of the Company in any manner a period of 5 (Five) years has not elapsed from the date of
whatsoever. such cancellation; and
k. become or remain a director of any insurance company,
iii. The Agent shall adhere to the code of conduct as specified below intermediary or insurance marketing firm.
and in the Agency Regulations. The Agent shall:
v. The Agent agrees to achieve the minimum business guarantee
a. identify himself as an insurance agent of the Company;
norms and minimum persistency norms as prescribed by the
b. show the agency identity card to the prospect and also
Company from time to time.
disclose his Appointment Letter to the prospect on demand;
c. disseminate the requisite information in respect of insurance
vi. The Agent agrees that all the sales material including the sales
products offered for sale by the Company and take into
kits, fact finders, proposal forms, premium receipt formats,
account the needs of the prospect while recommending a
sales literatures, standard benefit illustrations, product
specific insurance plan;
brochures, other literature containing the Company’s product
d. where he represents more than one insurer offering same line
specifications, frequently asked questionnaires, brochures and
of products, he will dispassionately advice the policyholder
all other ancillary documentation and other Company material
or prospect on the products of all insurers whom he is
provided to the Agent by the Company hereunder or pursuant
representing and the product best suited to the specific needs
hereto, shall at all times remain the property of the Company
of the prospect;
alone and shall be accounted for and returned to the Company
e. disclose the scales of commission in respect of the insurance
upon termination of the appointment.
products offered for sale, if asked by the prospects;
f. indicate the premium to be charged by the Company for the
vii. The Agent shall ensure that:
insurance product offered for sale;
g. explain to the prospect the nature of information required in a. the features of the insurance policy are explained
the proposal form by the Company, and also the importance accurately to and understood by the prospect/policyholder
of disclosure of material information in the purchase of an and shall not engage in mis-selling of insurance products;
insurance contract;
b. the information in a proposal form is verified and the
h. bring to the notice of the Company every fact about the
proposal forms do not carry incorrect additions or deletions
prospect relevant to insurance underwriting, including any
or blanks or any unauthenticated over-writings, before
adverse habits or income inconsistency of the prospect,
submitting the same to the Company and the Company is
within the knowledge of the Agent, in the form of a report
informed of any insurance policy that has not been
called “Insurance Agent’s Confidential Report” along with
delivered to or received by the policyholder;
every proposal submitted to the Company wherever
applicable, and any material fact that may adversely affect c. he does not engage in the marketing of products over any
the underwriting decision of the Company as regards distance marketing modes;
acceptance of the proposal, by making all reasonable
enquiries about the prospect; d. he does not collect or receive any premium amounts or any
i. obtain the requisite documents at the time of filing the money from the prospects or policyholders in his own
proposal form with the Company and other documents name;
subsequently asked for by the Company for completion of the e. he informs the Company immediately if any of his relatives
proposal; are employed/appointed by the Company in any capacity;
j. advise every prospect to effect nomination under the policy; and
k. inform promptly the prospect about the acceptance or
rejection of the proposal by the Company; f. he shall convey to the prospects/policyholders that
l. render necessary assistance and advice to every policyholder payment of benefits under the policy is subject to the
on all policy servicing matters including assignment of applicable terms and conditions of the policy and is not
policy, change of address or exercise of options under the guaranteed in all circumstances.
policy or any other policy service, wherever necessary; and
m. render necessary assistance to the policyholders or claimants viii. The Agent shall not misrepresent to the prospects/policyholders
or beneficiaries in complying with the requirements for that the Company carries on any other business or services or
settlement of claims by the Company. will process servicing requests or claims or other matters on a
guaranteed timeline.
iv. The Agent shall not:
ix. The Agent shall not charge an administration fee or service
a. solicit or procure insurance business without being appointed charge or any other charge to the proposer/policyholder in
to act as such by the Company; relation to life insurance business.
b. induce the prospect to omit any material information in the
proposal form; x. The Agent shall conduct business based on proper ‘needs
analysis’ of the prospect and shall not tie or bundle insurance
Appointment Letter (T&C)_Version 1.5_20th June, 2019 2
 Private & Confidential

compulsorily with any other product or service. The Agent shall and without any deductions, in order to ensure the receipt of the
ensure that he complies with the Anti Money Laundering Policy same by the Company, within 24 hours (excluding bank and
of the Company. postal holidays) of its collection from a proposer/policyholder
in accordance with section 64VB of the Act.
xi. The Agent will with a view to conserve the insurance business
already procured through him, make every attempt to ensure ii. The Agent shall be liable for any damage or claim arising out
remittance of the premiums by the policyholders within the of delay in deposit / delivery. It shall be the duty of the Agent,
stipulated time, by giving notice to the policyholder orally and at all times, whether the Company demands the same or not, to
in writing. In the event the Agent opts to collect premiums, he forthwith and without any delay whatsoever render proper
shall do so in accordance with the terms of the Appointment account of, and hand over to the Company, anything collected
Letter and the instructions provided by the Company, from time by the Agent from the proposer / policyholder.
to time. iii. The Agents who opt to collect renewal and modal premiums will
be required to enter into additional standard terms and
xii. The Agent shall resolve the complaints of the policyholders or conditions as prescribed by the Company, which terms and
give satisfactory reply to the Authority in matters related to conditions will form part of the Appointment Letter.
such complaints, after intimating the Company of the query
received by him and his response to the same. The Company iv. Save and except for premium or initial deposits accompanying
may respond directly to the complainant or suggest changes to the proposals, the Agent shall have no authority to receive or
such response, which the Agent shall duly incorporate, before collect any other monies whatsoever from the
responding to the complainant/querist. proposer/policyholder on behalf of the Company.

xiii. The Agent hereby acknowledges receipt of the Agent’s 8. Commission:

Handbook and agrees to abide by the same and to any changes
in the Agent’s Handbook from time to time. i. The Company will pay commission to the Agent on the
following for the Term subject to the terms and conditions that:
xiv. The Agent shall comply with the directions issued by the a. Individual insurance contracts procured by the Agent;
Authority or the Company, cooperate with any inspection or
enquiry conducted by the Authority or the Company, allow b. Group insurance contracts procured by the Agent; and
access to his books of accounts, records and documents to the
designated representatives (whether internal or external) of the c. Renewal of individual and group insurance contracts
Authority or of the Company with respect to any investigation procured by the Agent.
or inspection, if any, by the Authority or the Company on the ii. Commission will be payable at the standard rates applicable to
matters pertaining to the insurance business undertaken by the the products of the Company in accordance with Insurance
Agent. The Agent will submit periodic returns or furnish any Laws and subject to the Company’s rules in force at the time
information relating to his activities as an Agent as required by when the insurance policies are sourced and/or renewed. The
the Company or by the Authority from time to time, within the standard commission rates for insurance policies will be stated
specified timelines. in the Agents Handbook as updated from time to time and shall
be subject to statutory limits as specified under the applicable
xv. When requested by the Company to do so or in case of litigation laws as amended from time to time.
or threatened litigation against the Company, the Agent shall
promptly advise the Company on matters, in writing, including iii. It is agreed and understood that all commission and renewal
details of the circumstances under which the Agent solicited or commission will be paid in arrears on a monthly basis and in
procured or delivered any policy. any event after the receipt of premium in full on the underlying
policy being issued/renewed. It is further agreed and
xvi. The Agent shall not allow or offer to allow, either directly or understood that if any insurance policy is cancelled at any time
indirectly, as an inducement to any person to take or renew or for any reason whatsoever including cancellation within the
continue an insurance policy, any rebate of the whole or part of free-look period, no commission shall be payable to the Agent
the commission payable or any rebate of the premium shown and any commission already paid will be in the discretion of the
on the policy, except such rebate as may be allowed in Company either adjusted against future commission payable to
accordance with the published prospectuses or tables of the the Agent in accordance with the Appointment Letter or must
Company, provided that acceptance by an Agent of be returned to the Company by the Agent in full within 30
commission in connection with a policy of life insurance taken (Thirty) days of the Agent being notified of the cancellation.
out by himself on his own life shall not be deemed to be
acceptance of a rebate of premium under this Clause, if at the iv. In addition to the commission payable, the Company may in its
time of such acceptance, the Agent satisfies the prescribed discretion, pay other incentives or bonuses to the Agents or
conditions establishing that he is a bona fide Agent in other benefits in accordance with the Company’s schemes/
accordance with the Insurance Laws. programmes notified from time to time and subject to the Agent
fulfilling the criteria laid down in the such schemes/
xvii. The Agent shall ensure that any change in his address, facsimile programmes.
number, email ID etc. is duly informed to the Company by way
of a written communication at the Company’s address as v. The Company may from time to time introduce agency
provided in the Appendix and is updated in the Company’s segmentation initiatives and may in its discretion define and
records. prescribe eligibility and maintenance criteria for the same. The
Agent agrees to accept and abide by policy directives with
7. Collection of Premiums respect to agency segmentation issued by the Company from
time to time and terms and conditions prescribed therein.
i. All Agents are authorised to collect initial deposits vi. The Company reserves the right to amend and/or revise the
accompanying the proposals from the proposers. Without rates of commission and renewal commission, in whole or in
prejudice to the foregoing, the Agents are not authorised by the part, and to introduce and change the other
Company to collect any deposit or premium in cash or through incentives/bonus/other benefits for agents, from time to time
a bearer instrument. All initial deposits /premiums must be and the same shall be binding on the Agent.
collected in accordance with the Company’s Anti Money
Laundering Policy which forms part of the Agents Handbook. vii. The service tax applicable on the Agent’s commission and
Any initial deposit/ premiums collected by the Agent shall be related payments made to the Agent shall be in accordance with
deposited or delivered to the Company by the Agent forthwith the provisions of the Agent's Handbook as amended from time

Appointment Letter (T&C)_Version 1.5_20th June, 2019 3

 Private & Confidential

to time. All taxes (other than service tax), levies, tax deducted Appointment Letter due to the Agent’s death or otherwise will
at source, cess of any kind as also any interest or penalties on survive the cancellation or suspension or surrender of the
account of delay or default in payment by the Agent to the Appointment Letter.
Company thereof, will be to the Agent’s account.
9. Limitation on Authority of the Agent
viii. Except for the agreed commission payable by the Company to
the Agent and those other incentives/bonus/benefits as i. The Agent shall have no authority, for and/or on behalf of the
informed to the Agent by the Company from time to time as Company, to accept risks of any kind, to make, modify and/or
being payable, the Company shall not be obliged or liable to, discharge contracts, to extend the time for payment of any
make payments or provide compensation of any nature or premium, to bind the Company by any statement, promise or
reimbursement to the Agent on any grounds or for any reasons representation, to waive forfeitures or any of the Company’s
whatsoever, and the Agent shall accordingly not make any rights or requirements, or to place the Company under any
claim upon or against the Company. legal obligation by any act which is not within the authority
granted by the Company in these Terms and Conditions or
ix. All properties, documents, papers received by the Agent for otherwise in writing to the Agent. It is clarified that the Agent
and/or on behalf of the Company shall be received by the Agent shall not accept any legal notice(s) or make and/or file any
in a fiduciary capacity, on trust for the Company, and the Agent petitions, claims or statements, whether written or oral, enter
shall have no right or lien over the same including no right to into legal proceedings, for and on behalf of the Company, or
set-off the same towards his commission or any other payment represent the Company before any government or regulatory
due and payable by the Company. Any money shall be body including any court or judicial or quasi-judicial tribunal
accounted for promptly and separately from any other money unless otherwise authorized in writing.
including personal money of the Agent and shall not be used
for any personal or any other purpose whatsoever but shall be ii. The Agent shall not be and shall not hold itself out to be a
immediately, without delay, made over to the Company. general agent of the Company and the scope of agency under
this Agreement shall be strictly subject to and in accordance
x. Nothing in these Terms and Conditions Letter shall impair the with the provisions of the Insurance Laws pertaining to the
Company’s right to the exercise of its discretion in acting upon Agents and the provisions of the Appointment Letter.
any proposal for an insurance policy, and the Agent shall have
no right to any commission for submitting any proposal upon iii. Without prejudice to the provisions of Clause 9 (i) and 9 (ii)
which no insurance policy is effected with or is cancelled by the above, it is clearly understood, agreed and expressly declared
Company. Without prejudice to the generality of the aforesaid, that:
the Agent hereby agrees and acknowledges that the Company
shall not be bound and obliged to provide insurance cover to a. the Agent is not authorized to waive or change any
proposers introduced by the Agent. The decision of the provision of the insurance policies, receipts or
Company in this regard shall be final and binding. certificates;
xi. The Company is hereby given a prior lien upon all commission b. the Agent is not authorized and is expressly forbidden to
and other payments payable to the Agent under these Terms and bind the Company by any promise or agreement, to incur
Conditions or any other agreement with the Agent, as security any debt, expense or liability in its name or account;
for the payment of any claim or indebtedness whatsoever due c. the Agent shall not enter into any contract, incur any
or to become due to the Company from the Agent under these expense or obligation, or cause or permit the insertion or
Terms and Conditions or any other agreement with the Agent. distribution in any publication or otherwise, any
Any sums becoming due to the Agent at any time may be advertising or publicity matter which in any way
applied, directly, by the Company to the liquidation of any involves the Company without the prior written authority
indebtedness or obligation of the Agent to the Company, but the of the Company;
failure to so apply any sum shall not be deemed a waiver of the
Company’s lien on any other sums becoming due nor impair its d. the Agent shall not use or distribute any sales materials
right to so apply sums in future. that reference the Company or Company’s products,
without prior written consent of the Company except the
xii. In addition to the foregoing, the Company may, in its discretion, sales materials provided by the Company to the Agent.
outsource certain activities to the Agent in accordance with
applicable Insurance Laws. 10. Relationship:
xiii. On termination of the Appointment Letter due to the Agent’s Neither the term “Agent” and/or any other term/s used in the
death or otherwise (but not due to fraud), renewal commission Appointment Letter or in any of the writings or documents from
may be payable: the Company shall be construed as creating the relationship of
employer and employee between the Company and the Agent.
a. to the Agent, if the termination of the Appointment Letter is Subject to the provisions of the Insurance Laws and the
for any reason other than the Agent’s death, provided that Appointment Letter, the Agent, shall be free to exercise his own
such renewal commission becomes payable only if permitted discretion and judgment with respect to the persons from whom
under and in accordance with, the Company’s policies on the Agent will solicit proposals and procure insurance business,
such payment (including the Board approved policy for and with respect to performance of his obligations under the
Agents) and such payment is not prohibited by applicable Appointment Letter.
Insurance Laws.
11. Indemnification:
b. to the legal heirs (based on a valid succession certificate
submitted to the Company), if the termination of the Without prejudice to any rights of the Company, the Agent
Appointment Letter is due to Agent’s death, for so long as agrees to make compensation to and to indemnify the
such commission would have been payable only if permitted Company, and to keep the Company indemnified, saved and
under and in accordance with the Company’s policies on such harmless at all times from all costs, expenses, losses, outgoings
payment (including the Board approved policy for Agents) and damages of every kind including all legal fees and
and such payment is not prohibited by applicable Insurance expenses, which the Company may at any time incur or pay on
Laws, had such Agent been alive. account of any claim, garnishment, attachment or other legal
process or order of any kind which may be served upon the
xiv. For the avoidance of doubt, the above provisions regarding Company by reason of the breach by the Agent of any provision
payment of renewal commission on termination of the of these Terms and Conditions, any other writing or document,
Appointment Letter (T&C)_Version 1.5_20th June, 2019 4
 Private & Confidential

the law including Insurance Laws, by reason of the existence of

this or any other agent’s appointment by and between the i. On the issue of the final order for cancellation or suspension of
Company and the Agent or on account of any assignment the appointment, the Agent shall cease to act as an insurance
applicable to any such agent’s appointment. This Clause shall agent for the Company from the date of such final order and the
survive the suspension or cancellation or surrender of the Company will not register any new business by the suspended
Appointment. or cancelled agent. No renewal commission shall be payable
after the cancellation or suspension of the appointment on any
12. Termination: policies sourced while the Appointment Letter was in force
unless such payment becomes due in accordance with the
i. The Company may cancel or suspend the Appointment Letter provisions of Clause 8 (xiii).
by way of a written notice after giving the Agent a reasonable
opportunity of being heard on account of: ii. The Agent shall have no right to claim or recover from the
Company any damages or other compensation whatsoever for
a. the Agent violating the provisions of the Insurance Laws; and/or on account of and/ or upon cancellation or suspension or
b. the Agent attracting any of the disqualifications stipulated in surrender of his appointment.
section 42(3) of the Act or Agency Regulations;
c. the Agent failing to comply with the code of conduct stipulated iii. Upon cancellation or suspension or surrender of the
in these Terms and Conditions and the Agency Regulations; Appointment Letter,
d. the Agent violating or breaching the terms of the Appointment
Letter or any of these Terms and Conditions; a. the Agent shall return the Appointment Letter and the identity
e. the Agent failing to furnish any information relating to his/her card to the Company within 7 (Seven) days from the date of
activities as an Agent as required by the Authority or by the issuance of the final order effecting cancellation/suspension of
Company; his appointment as an Agent. In the event the Agent does not
f. the Agent failing to comply with the directions issued by the submit the Appointment Letter and the identity card to the
Authority from time to time; Company within the time as stipulated herein, the same shall
g. the Agent furnishing wrong or false information or concealing stand null and void from the date of issuance of the final order
or failing to disclose material facts in the application submitted effecting cancellation / suspension (applicable only in case of
for appointment of Agent or during the Term of the suspension or cancellation).
Appointment Letter or these Terms and Conditions;
h. the Agent not submitting periodical returns as required by the b. the Agent shall forthwith, without any delay or demur on any
Authority or by the Company; grounds, return to the Company, all instructions/ documents of
i. the Agent not co-operating with any inspection or enquiry any nature whatsoever, papers, instruments, moneys in his
conducted by the Authority; possession and/or made, or that became, available to him in the
j. the Agent failing to resolve the complaints of the policyholders course of the performance of his obligations by virtue of this
or failing to give a satisfactory reply to the Authority in this appointment.
behalf;
k. being either directly or indirectly involved in embezzlement of c. the Agent shall forthwith, without any delay on any grounds,
premiums / cash collected from policyholders / prospects on stop the usage of any marketing or promotional materials issued
behalf of Max Life; by Company to the Agent or developed by Agent on its own
l. the Agent failing to comply with the minimum business and shall remove the link of Company's website on the Agent's
guarantee norms and minimum persistency norms prescribed website, if earlier allowed by the Company.
by the Company from time to time; and any other reason as may
be communicated by the Company to the Agent. d. the Agent shall settle with the Company all pending matters
including any policy proposal/s pending and co-operate with
ii. Notwithstanding anything else stated elsewhere in these Terms and provide all necessary assistance to the Company, as may be
and Conditions, the Company may consider appointing an requested by the Company, so as to ensure that the Company is
Agent, whose appointment has been cancelled or suspended for not prejudiced in any manner and/or exposed to any disputes.
non-achievement of the minimum business guarantee norms
and / or the minimum persistency norms prescribed by the iv. Cancellation or suspension or surrender of this Appointment
Company, subject to the Company’s policies and rules from Letter shall in no way adversely affect the Company’s rights to
time to time. bring and/or take appropriate action to recover damages or
assets belonging to the Company in the possession of the Agent
iii. The manner of holding enquiry on the Agent shall be as per the or to set off any assets, any claim or any amounts owing by the
Agency Regulations and will be notified by the Company to the Company to the Agent, as the case may be.
Agent.
v. Recognizing the same to be improper, the Agent irrevocably
iv. The Agent who is aggrieved by the order of cancellation can and unconditionally agrees not to, at any time, during the Term,
appeal to the Company within 3(Three) months from the date directly or indirectly, either on his own behalf or through any
of receipt of the order. The Company shall appoint an Appellate other person in any manner whatsoever:
Officer who shall examine the appeal and give his decision in
the matter in writing within 30 (Thirty) days of the receipt of a. approach, canvass, solicit or otherwise endeavor to entice
the appeal. away from the Company any of its employees or insurance
agents, whether or not such person would commit a breach of
v. In case the Agent wishes to resign from the relationship of contract;
agency or surrender his agency with the Company, he may do b. approach, canvass, solicit or otherwise endeavor to entice
so by surrendering this Appointment Letter and identity card to away from the Company any proposers or any of its
the Company, accompanied by a written communication from policyholders for the purpose of inducing or attempting to
him informing the Company of his resignation or surrender of induce such policyholders or proposers to withdraw
agency. The Company shall issue a cessation certificate in the proposals, cancel, lapse or otherwise surrender policies issued
format as provided in the Agency Regulations and the by the Company.
Insurance Laws within a period of 15 (Fifteen) days from the
date of his resignation or surrender of appointment in the vi. This Clause shall survive the cancellation or suspension or
manner as specified above. surrender of these Terms and Conditions.

13. Consequences of Termination: 14. Waiver:

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 Private & Confidential

Any failure of the Company in any instance, to cancel or The Agent agrees to keep confidential all proprietary and
suspend the agency appointment of the Agent when cause for confidential information disclosed by the Company or any
such cancellation or suspension exists, or to insist upon proposer or policyholder, any information concerning or
compliance with any of the limitations, terms, provisions and relating to or connected with the business of the Company
conditions of these Terms and Conditions, shall not be which may become available to the Agent during the currency
construed as a waiver of any of the Company’s rights or of any of the appointment, including these Terms and Conditions,
such limitations, terms, provisions and conditions, or of the Agents Handbook, including the schedules thereto, any notices
right of the Company to thereafter enforce its rights and/or including guidelines or circulars, any information of any
insist upon such compliance. This Clause shall survive the proposers or policyholders and agrees not to disclose any such
cancellation or suspension of the Appointment Letter. information to any third party or use any such information for
any third party’s or the Agent’s own purposes. At the
15. Assignment: Company's request, the Agent will promptly return/hand-over
any documents and information that may have been supplied
The rights, interests and claims of the Agent against the by the Company to the Agent or obtained from proposers or
Company arising out of these Terms and Conditions are not policyholders. Proprietary and confidential information shall
assignable, and no assignee shall acquire any rights thereto, not include information which (i) enters the public domain
without the prior written consent of the Company. through no fault of the Agent; (ii) is in possession of the Agent
prior to the receipt under the Appointment Letter; (iii) is
16. Notice: required to be disclosed under law or by order of any Court (for
which prior written notice shall be given by the Agent to the
i. Written notice to the Agent under the Appointment Letter or Company); and (iv) is independently developed by the Agent.
these Terms and Conditions will be in English and by This Clause shall survive the cancellation or suspension or
registered post acknowledgment due or courier or facsimile or surrender of the Appointment Letter.
electronic transmission or by publication in any official
publication or bulletin or web portal of the Company or by 18. Severability:
notice at the Company’s office, by any other means, except that
a notice referred to in Clause 12 shall not be given by means If any provision of these Terms and Conditions is held to be
of such publication. If notice is given by publication whether invalid, in whole or in part, such provision (or relevant part, as
in an official publication or bulletin or web portal of the the case may be) shall be deemed not to form part of these
Company or at the office of the Company, it shall be deemed Terms and Conditions. In any event, the enforceability of the
to have been given whenever published as above. If written remainder of the Terms and Conditions will not be affected.
notice to the Agent is given by registered post acknowledgment
due, it shall be deemed to have been received by the Agent 19. Governing Law and Jurisdiction
within 72 hours of posting, to the address of the Agent recorded
with the Company (intervening public holidays at the place of these Terms and Conditions are subject to and shall be
receipt to be discounted). If written notice to the Agent is given governed by Indian laws. The parties hereby expressly submit
by courier, it shall be deemed to have been received by the to the jurisdiction of the courts in New Delhi for all matters
Agent within 24 hours of dispatch, to the address of the Agent relating to or concerning these Terms and Conditions. This
recorded with the Company (intervening public holidays at the Clause shall survive the cancellation or suspension or surrender
place of receipt to be discounted). If written notice to the Agent of the Appointment Letter.
is given by facsimile or electronic transmission, it shall be
deemed to have been received by the Agent upon receipt of 20. Survival and Amendment:
confirmation of proper transmission by the Company, if sent
on a working day for the Agent. The termination of the Appointment Letter shall not affect
provisions which are intended, whether expressly or otherwise,
ii. Save as otherwise provided under Clause 16 (i), all notices and to survive such termination. No amendment to these Terms and
other communication in respect of the Appointment Letter shall Conditions shall be binding unless the same is in writing and
be given in writing in English by registered post signed by the Company.
acknowledgement due or courier or facsimile transmission to
the addressee party at its address and facsimile number set forth 21. Exceptions:
in the Appendix below.
Should any clause of these Terms and Conditions be affected
iii. If the parties wish to effect change of address or facsimile by any proceeding of the Authority or any other authority, the
number or email identification hereafter, they shall give prior Agent and the Company agree to jointly and/or severally
notice to each other in accordance with the provisions of this represent to the Authority or such other authority and shall be
Clause. bound by any instructions and/or directions passed by the
Authority or such other authority in this regard.
17. Confidentiality:

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 Private & Confidential

APPENDIX (refer Clause 16above)

(a) The Company: Max Life Insurance Company Limited

Address: Max Life Insurance Co. Ltd., Unit No. 201, 2Nd Floor, Shree Ganesh Plaza, Shri Hari Narayan Kute Marg, Nashik-422002
(Maharashtra) District - Nashik

Office number:

(b) Agent name: CHHAYA SUNIL AHER

Address: NA Takali Vinchur(Niphad)TAKALI VINCHUR Nashik Maharashtra9890907396

Mobile number:9890907396
Email Id: [email protected]

Acknowledgement and acceptance by Agent

The terms and conditions applicable to the undersigned upon appointment as an agent of the Company and
provided hereinabove have been read and fully understood by me and I hereby agree to abide by the same.

(Signature)

Agent Name: CHHAYA SUNIL AHER

Date:

Place:

For Max Life Insurance Company Limited

Amit Puri
Designated Official

Appointment Letter (T&C) _Version 1.5_20th June, 2019 7

Declaration:

I understand and agree that the fees collected for IC 38 training, examination of
agents is non-refundable.
I authorize Max Life to remit applicable fee to IRDA and NSEIT on my behalf.
I confirm that on my demise, if the company pays the hereditary commission to the
nominees named by me in nominee section, the same will give a valid discharge to
the Company irrespective of whether the said nominees are my legal heirs or not.
I hereby declare that I have verified the bank account details and authorize Max
Life Insurance to credit any payouts (as and when eligible) in the mentioned
account.
I understand that, I have disclosed my confidential personal information/documents
with Max Life and hereby consent and authorize Max Life to seek/ to store/ and or
to share, (within India or outside) my personal information shared by way of this
application form or otherwise, including my Aadhaar number, with Government and
/ or Regulatory or Statutory as per legal or regulatory framework put in place for
the same.

Disclaimer:

Upon providing the confirmation number, you confirm that the details and information’s
provided by you is true and correct in all aspects and the same have been dully vetted
by you and nothing contained therein is false and incorrect and you agree to abide by
the terms & conditions without any deviation. You also agree that in case the
information is found to be incorrect at later stage, you shall be solely responsible for the
consequences, if any, including cancellation of your application/ agency appointment.

By providing the confirmation number, you agree to abide by the attached Terms And
Conditions and will also consider all your information has been duly validated and
authenticated by you.

Confirmation No

4173