Page 203 - Ebook IC S01

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FORM - IRDAI - 6 – AF
1. Current Corporate Surveyor and Loss Assessor License Details

(1) SLA no. ………………………………….
(2) Date of Expiry ………………………………….
(3) Name of the Firm/Company ………………………………….
(4) Address of Company/Firm …………………………………
2.Departments allocated to directors/partners

Dept Fire Marine cargo Marine Hull Engg Motor Misc Crop Insurance LOP

License details of
directors/partners
and level of
membership
3.It is requested that the above license may be renewed for a further period of three years for the following classes of
insurance and level of membership allotted to directors/partners:

Dept Fire Marine cargo Marine Hull Engg Motor Misc Crop Insurance LOP

License details of
directors/partners
and level of
membership

4. It is hereby declared that-
(1) No director/ partner of our Company/ Firm has been found to be of unsound mind by a Court of
competent jurisdiction;
(2) No director/ partner of our Company/ Firm has 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;
(3) No director/ partner of our Company/ Firm has been found guilty of or to have knowingly participated in
or connived at any fraud, dishonesty or misrepresentation against an insurer or an insured in the course of
any judicial proceedings relating to any policy of insurance or the winding up of an insurer or in the
course of an investigation of the affairs of an insurer; and
(4) No director/ partner of our Company/ Firm is a minor.
(5) No director/ partner of our Company/ Firm shall violate the code of conduct specified by the regulations
made by the Authority.
(6) All director(s)/ partner(s) of our Company/ Firm possess the requisite qualifications and practical training
as specified by the regulations made by the Authority.
(7) All director(s)/ partner(s) of our Company/ Firm have passed such examination as specified by the
regulations made by the Authority.
5.It is declared that each one of the Director(s) / partner(s) of the firm who was a partner/ Director when the above
mentioned license was issued and who is now a Director(s) / partner(s)continues to satisfy the requirements of clause
(D) of subsection (1) of Section 64UM of the Act.
6.It is also declared that all the director(s)/partner(s) whose address, date of birth have been submitted
(1) have been in practice as Surveyor and Loss Assessor on 26th October,1968 ,or
(2) hold a degree of a recognized university in any branch of engineering, or

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