Name of the candidate *

Date of Birth *

Address *

PIN *

Mobile *

Tele Phone *

Email ID *

PAN No.(User Id) *

Note: Existing users Please Add PANNO-1 for Re-registration

UIDAI Aadhaar Card No. *

Sponsorship Details *

Name of the Company

Address

State *

PIN *

Contact Person

Phone

Email ID

Please select Qualification for eligibility of 25 hours training *

Associate/ Fellow of the Insurance Institute of India, Mumbai

Associate/ Fellow of the Institute of Risk Management, Mumbai

Associate/ Fellow of the Institute of Actuaries of India

Chartered Financial Analyst of ICFAI.

Associate/ Fellow of Chartered Insurance Institute, London

Post graduate qualification of the Institute of Insurance and Risk Management, Hyderabad

Associate/ Fellow of – Institute of Chartered Accountants of India, Institute of Cost Accounts and Works of India, Institute of Company Secretaries of India

Eligible for :

Required Hours :
Note : Certificate will be generated based on Required Hours.

Professional Qualification

Broking Module Opted for *

Payment Amount : Rs.2360.00/- ( Fresh Course Registration : Rs. 2000/- + 18% GST)

Please Upload Photo *

Your photograph in jpeg format, file size below 30 kb. File name should be given as your PAN Number_Name (e.g. AJCPK1122R_PriyankaDeshmukh.jpeg)

Upload Photo :

Course Duration : 60 Days. For Any support, have a look at Contact US page
Please verify PAN NO, E-mail ID and Aadhaar Number before submit your registration form.

I am aware of the Qualification and Eligibility Criteria for Brokers Online Training as prescribed by IRDAI and declare that I have fulfilled the same. I further declare that the information given by me is true and I am aware that if any deviation from facts is noted or noticed, my application will be considered null and void