[go: up one dir, main page]
Scribd
Upload
446 views1 page

Fit & Proper Criteria - Form

This document contains a declaration and undertaking form for the principal officer/directors/managing partners of a corporate agent applying for registration with the Insurance Regulatory and Development Authority of India. The form requires applicants to disclose any past regulatory actions, criminal proceedings, disqualifications, investigations or other issues relevant to assessing if they meet the authority's fit and proper criteria to be registered as an agent. Applicants must sign to confirm the information provided is true and complete, and agree to continue updating the authority on any relevant changes or events in the future.

Uploaded by

sandeep tiwari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
446 views1 page

Fit & Proper Criteria - Form

This document contains a declaration and undertaking form for the principal officer/directors/managing partners of a corporate agent applying for registration with the Insurance Regulatory and Development Authority of India. The form requires applicants to disclose any past regulatory actions, criminal proceedings, disqualifications, investigations or other issues relevant to assessing if they meet the authority's fit and proper criteria to be registered as an agent. Applicants must sign to confirm the information provided is true and complete, and agree to continue updating the authority on any relevant changes or events in the future.

Uploaded by

sandeep tiwari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Annexure – 1

[See regulation 7(2)(g)]


INSURANCE REGULATORY AND DEVELOPMENT AUTHORITY OF INDIA (REGISTRATION OF
CORPORATE AGENT)REGULATIONS, 2015
Declaration and Undertaking of Principal officer/ Directors/ Managing Partners (A separate form needs to be
submitted by each individual)

S. No Fit & Proper Criteria Yes/No (If Yes,


furnish full
details)

a) Have you ever registered or obtained license from any of the regulatory authorities
under any law such as SEBI, RBI, IRDA, PFRDA, FMC etc.
Have you carried on business under any name other than the name stated in
b) thisapplication
Have you ever been refused or restricted by any regulatory authority to carry on any
c) business, trade or profession for which a specific license registration or other
authorization is required by law.
Have you been ever censured or disciplined or suspended or refused permission or
d) license or registration by any regulatory authority to carry on any business activity
Have you been subject to any investigations or disciplinary proceeding or have been
e) issued warning or reprimand by any regulatory authority
Have you been convicted of any offence or subject to any pending proceedings
f) under any law
Have you been banned from entry from any profession / occupation at any time
g)
Details of prosecution, if any, pending or commenced or resulting in conviction in
h) the past for violation of economic laws and regulations
i) Details of criminal prosecution, if any, pending or commenced or resulting
inconviction in the past against the applicant
J) Do you attract any of the disqualifications envisaged under Section 164 of
theCompanies’ Act 2013?
k) Have you been subject to any investigation at the instance of
Governmentdepartment or agency?
Have you at any time been found guilty of violation of rules / regulations /legislative
l) requirements by customs / excise / income tax / foreign exchange /other revenue
authorities, if so give particulars
Have you at any time come to the adverse notice of a regulator such as SEBI,IRDA,
m) MCA, PFRDA.(Though it shall not be necessary for a candidate to mention in the
column about orders and findings made by regulators which have been later on
reversed / set aside in toto, it would be necessary to make a mention of the same, in
case the reversal/setting aside is on technical reasons like limitation or lack of
jurisdiction, etc, and not on merit. If the order of the regulator is temporarily stayed
and the appellate /court proceedings are pending, the same also should be
mentioned).

Has any of your group company/associate company/related party been carryingany


n) license issued by the IRDA
Any other explanation/information in regard to items I and II and other
o) information considered relevant for judging fit and proper criteria of the
applicant

Undertaking
I confirm that the above information is, to the best of my knowledge and belief, true and complete. I undertake to keep
the Authority fully informed, as soon as possible, of all events, which take place subsequent to my appointment,
which are relevant to the information provided above.
Signature
Name
Designation
Date & Place

You might also like