User Confirmation
Corporate Agent / IMF / Web Aggregators/Insurance Broker AV Registration Form
NOTICE:
Kindly ensure that you have registered yourself afresh, by filling in the 'Training Registration Form' on IRDAI portal (
http://www.iiiexams.org/
) and the URN you are entering is the newly generated URN
Enter URN No.
*
:
Select Service Provider Name
*
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Applicant Details
Application Date:
Reference Number:
Name Initial:
Applicant Name:
Applicant Father Name:
CoR :
Applicant Date of Birth:
Gender:
Phone Number:
Mobile Number
*
:
Email ID
*
:
Pan:
Nationality Country:
Urban/Rural:
Corporate Details
Corporate Type:
Company Type:
Permanent Address
House Number:
Street:
Town:
District Name:
State Name:
Pin code:
Current Address
House Number:
Street:
Town:
District Name:
State Name:
Pin Code:
Qualification
Qualification:
Other Qualification:
Basic Qualification:
Basic Qualification Board Name:
Basic Qualification Roll Number:
Basic Qualification of Passing:
Applicant Training Details
Is Renewal Applicant:
Applicant Status:
Training Hours:
Insurance Category:
Applicant Photo And Sign
Applicant Photo:
Applicant Sign:
GSTIN State
*
:
GSTIN No.:
Amount For Training:
Service Tax:
Swach Bharat Tax:
Krishi Kalyan Tax:
CGST:
SGST:
IGST:
Service Tax 5:
Total Amount:
Mode of Training :
(Web + Mobile App) based Online Training
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