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Sponsorship Form

The document is a sponsorship form for LIC of India, requiring mandatory information from the applicant including personal details, qualifications, and contact information. It outlines the training and examination details for the applicant, specifying the training mode, location, and examination body. The form must be filled out completely and includes sections for signatures and stamps from relevant authorities.

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meghaaassociates72
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225 views2 pages

Sponsorship Form

The document is a sponsorship form for LIC of India, requiring mandatory information from the applicant including personal details, qualifications, and contact information. It outlines the training and examination details for the applicant, specifying the training mode, location, and examination body. The form must be filled out completely and includes sections for signatures and stamps from relevant authorities.

Uploaded by

meghaaassociates72
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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SPONSORSHIP FORM

All the fields are mandatory

Sponsorer Company Name : LIC OF INDIA


In Charge / Authorized Person Name: Marketing Manager
License type : Individual
Insurance Category : Life
Is Specified Person : No. If yes, License No………………….…

APPLICANT DETAILS
Application Date (ddMMyyyy) : ……………………………………………………….
Personal Information
Applicant Name : ………………………………………………………. Applicant Photo
Father / Husband Name : ……………………………………………………….
Category : General / SC / ST / OBC
Area : Urban / Rural I
PAN No : ……………………………………………………….
Driving License No : ……………………………………………………….
Passport No : ……………………………………………………….
Voter ID No : ……………………………………………………….
Photo ID card of Govt : ……………………………………………………….

Basic Qualification Details : Class X / Class XII


Board Name : ………………………………………………………
Roll No. : ……………………………………………………… Application Signature
Month and Year of passing : ……………………………………………………..
Education Qualification / any of below
[ ] Class X [ ] Class Xll
[ ] Graduate [ ] Post Graduate
[ ] M.B.A [ ] Others………………..
Date of Birth (dd/mm/yyyy) : ………………………………………………………
Sex : Male / Female

Primary Profession : ……………………………………………………..


Nationality : INDIAN
CONTACT INFORMATION
Current Address: Permanent Address:
House No…………………………………………………….. House No………………………………………………………….
Street/Road…………………………………………………. Street/Road………………………………………………………
Town City…………………………………………………….. Town City……………………………………………………......
District…………………………………………………………. District……………………………………………………...........
State: TELENGANA State: TELENGANA
PIN Code ………………………………………… PIN Code ……………………………………….
Phone / Mobile No…………………………..
Email ID…………………………………………..

Other Information Insurer Ref No. ………………………………….

APPLICANT TRAINING DETAILS


Training Mode : ONLINE
ATI Location : JANGAON
Training Institute Name : AGENTS TRAINING CENTRE
Accreditation No. : IRDA/ATI/ANT/WARANGAL/010

APPLICANT EXAMINATION DETAILS


Examination Mode : Online
Examination Body : NSEIT, MUMBAI
Examination Centre : WARANGAL
Examination Language : TELUGU / ENGLISH

Signature and stamp of Signature of ABM / PRINCIPAL.


DO/CLIA AND BO Stamp

(Use black-gel pen and write in BLOCK LETTERS)


Division Name : WRANGAL

Branch Name :

Candidate Name : …………………………………………………………………


(In case of renewal; Name of the Agent)

Unique Reference No. : …………………………………………………………………


(For Few cases)

Agency Code no. : ………………………………………………………………..

License Number : …………………………………………………………………

PHOTOGRAPH (Passport Size)

SIGNATURE

Signature and stamp of SBM / Chief Mana


Dev.Officer/CLIA BO stamp

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