Personal Information

Title : Mr Ms Mrs

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Nominee Details

Bank A/C Details

Premium Details


I hereby affirm that the particular given overleaf are true and correct in every respect. I hereby undertake to work diligently for the company and will be honest in my dealing with company and the public. I also undertake to a render every possible assistance and service to my customers . I further agree to abide by the rules and regulations of the company and the terms of my appointment . I also undertake not to engage myself in any work or business in association with any other company . I will also be liable, for payment of the taxes, including TDS on my Commission, Incentive, Bonuses, as per the income Tax Act. If I failed to achieve promotion quota of each Rank, I will not claim field care plan benefits that is Field Special Incentives. 1. In any case Registration fee is Not Refundable Not Transferable.
2. All details provided are correct and true. In case of false/incorrect information, I shall be hold responsible.
3. All disputes are Subject to Warangal Jurisdiction.
4. Right of giving registration is reserved.
5. I will critically study each product before sale.
6. I case of any disputes or different in any matter the decision of the company shall be final and binding on me.
7. I shall guide and help my clients to process their claims in consultation with the company officers.
8. In case of any misbehavior or my part. I am aware that my agency will be terminated.
9. All the remittances are made directly at the company’s office only. The company shall not be responsible for any payment made anywhere else or to anybody else. The Sales officer of the company is not authorized to issue any receipt unbelief of the company.
10. I authorize my top code/senior to receive my commission Vrs /its chqs / Educational kit if any.