Apne liye. Apno ke liye.

AGENCY
APPLICATION KIT

REGION: BRANCH:
URN:
UM NAME:
UM CODE:
lA NAME:
lA CODE:
IA TYPE: Regular Direct

AGENCY TYPE: Insurance Agent POSP

ENROLLMENT TYPE: Fresh Transfer Recoding Composite

For Internal Circulation Only

 CHECKLIST FOR INSURANCE AGENT (IA/POSP)

Sr. No. DOCUMENT CHECK

1 Agency Application Form

2 Form I-A/ I-B/I-C

3 PAN Copy

4 Address Proof

5 Education Proof

6 Examination result copy

7 Bank Account Proof

8 Nomination Form

Date : Name of Sales Support Associate:

Place : Contact Number:

Branch Seal : Signature:

Note:
1. All supporting documents to be self attested by applicant and O.S.V by UM/BSM.
2. SSA has to ensure proper documentation before upload in CMS.
3. SSA has to ensure that candidate sign on all the pages.

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 1

 PAN:

IRN:

Apne liye. Apno ke liye. URN:

AGENCY APPLICATION FORM (INDIVIDUAL) (For Retail Agency)

Registration Information: (For Office use)

Date of Application:

UM Code: UM Name:

Branch code: Branch: Region:

Recent Passport
Size Photograph

(Please sign within the box)

(FURTHER DETAILS TO BE FILLED BY THE CANDIDATE)

Personal Information:

1. Name: Mr Mrs Ms Dr Mx (as appearing on Permanent Account Number (PAN)) :

First Name Middle name Surname

2. Father’s /Husband’s Name:

3. PAN Number:

4. Gender: Male Female 5. Marital Status : Unmarried Married

6. Maiden Name (Full name before marriage in case of married woman applicant):

7. Date of Birth: D DMM Y Y Y Y

8. Income: Self+Spouse per annum.

9. Caste: General SC ST OBC

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 2

 10. Basic Qualification: (Tick Highest Qualification earned)
Class X Class XII Graduate Post Graduate Others

Provide mandatory details mentioned below)

Roll no: Board / University:

Year of Passing:

11. Address for Communication: (Please leave a space betw een each part of the address)

Flat/Bldg:

Road/Sect:

Area:

Land Mark:

City : State Pin code

Landline : Mobile:

Email ID:

12. Permanent Address: (If different from communication address)

Flat/Bldg:

Road/Sect:

Area:

Land Mark:

City: State: Pin code:

13. Occupation:
Self Employed (Govt.) Service (Pvt .) Service Retired
Student Home maker Others

14. Do you hold agency with any Life/General Insurance company / Health /Mono line insurer:
Yes No (If yes, please provide details)

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 3
 15. Have you ever surrendered your license/agency or has your license/agency ever been cancelled/
Blacklisted: Yes No (if yes, please give details along with cessation certificate):

16. Do you have any tie up with any other insurer as an employee or director or promoter Or hold
any insurance activity related license or hold any position with any Corporate Agent /
Broker/ TPA / Insurance Marketing Firm/ any other insurance intermediary:
Yes No (if yes, please give details)

17. Are you one of the promoter or partner or director in any firm or company which is associated
with SBI Life Insurance Co Ltd? Yes No
If answer to the above questions is yes, please share details of the firm/company.
Name of the firm/Company

PAN of the firm/Company

TIN of the firm/Company

18. Are you associated/empaneled with SBI Life in capacity of a vendor Or employee of any such vendor
Or landlord of any premises which is rented to SBI Life? Yes No

19. Are you related to any employee of SBI Life Insurance Co. Ltd or State Bank of India (SBI)/any
of SBI Associates: Yes No If Yes,

NAME:

DESIGNATION: Relation with Self:

Details of Bank/SBI Associate /SBI Life Insurance Office:

ADDRESS:

20. If answer to above question is ‘Yes’, kindly specify if you are dependent on the aforesaid relative:
Yes No

21. Whether you are ex-employee of SBI or its associate banks: Yes No
If the answer to the above question is ‘Yes’, then specify the last date in the Banks with a
copy of the Bank’s letter.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 4
 22. Bank Details
Bank Name:
Bank Account Type:

Bank Account Number:

Bank IFSC Code:

23. Nomination Details :

Name:
Date of Birth: D DMM Y Y Y Y Gender : Male Female
Percentage: Relationship with nominee:
If address of nominee is same as candidate Yes No (If No, then the following to be filled)

Address:

In case of Minor Nominee fill details for appointee below:

Name of Appointee:
Relationship with Minor Nominee:
DOB : D D M M Y Y Y Y
Address:

If the sign of application is in any other language? Yes No

Witness Name:
Witness address:
Witness Signature:
Witness Occupation:

24. Declaration

I, (Name of IA/POSP) hereby declare that

(a) I have not 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;
(b) I have not been found guilty of or to have knowingly participated in or connived at any fraud,
dishonestly or misrepresentation against an insurer or an insured.

Note : Answer to all the above questions is mandatory. Signature of the candidate
Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 5
 Terms & Conditions on Appointment Of Insurance Agent/POSP
The Insurance Agent/POSP of the SBI LIFE INSURANCE COMPANY LTD, on his appointment as the
Insurance Agent/POSP of the Company, has to strictly adhere to the terms and conditions as laid down
below and also as amended from time to time by the Company.
The SBI LIFE INSURANCE COMPANY LTD, [hereinafter called as the Company], incorporated under
the Companies Act, 1956 for carrying on the business of life insurance and is desirous of obtaining the
services of the agent for the purpose of soliciting and procuring life insurance business for the Company
and for performing such other functions which are incidental to his acting as an Insurance agent and as
may be entrusted to him by the Company from time to time, has framed the following terms and
conditions to be strictly followed by its Insurance Agents/POSP
The Agent, who holds a valid appointment letter to act as an Insurance Agent/POSP of the Company, has
to strictly follow the following terms and conditions:

1. Definitions:
The following words and expressions used in terms & conditions shall have the meaning assigned to
them as under and any words or expressions used herein but not defined shall have the meaning
assigned to them in the Insurance Act, 1938, the Insurance Regulatory and Development Authority Act,
1999 or the rules and regulations made under those enactments.
a) “Act” means the Insurance Act, 1938;
b) “Unit Manager” means the employee of the Company under whose supervision and control the
Agent is for the time being placed;
c) “Agent” means the person appointed to act as an Insurance agent of the Company in terms of
this Agreement;
d) “Company” means the SBI Life Insurance Company Limited;
e) “IRDAI” means the Insurance Regulatory and Development Authority of India established under
the IRDA Act; and
f) “IRDA Act” means the Insurance Regulatory and Development Authority Act, 1999 (41 of 1999).
g) “Rules and Regulations” means the rules and regulations made under the Act and the IRDA
Act and include the orders, directives, circulars, guidelines and notifications issued by the IRDAI
from time to time.

2. Appointment:
The appointment of Insurance Agents/POSP shall be subject to the review conducted by SBI Life
Insurance Co. Ltd from time to time, except for termination due to fraud or non-performance.
a. The terms and conditions shall govern the appointment of an Agent for the purposes of soliciting
and procuring life insurance business (“business”) for the Company in such areas as may be
determined by the Company and notified to the Agent and to perform such other functions as
are incidental to his acting as an Insurance Agent and as may be entrusted to him by the
Company from time to time. The Agent has to accept the said appointment and the terms and
conditions governing such appointment and the agent will be designated as “Insurance
Agent”/POSP
b. The Agent shall not solicit or procure business from person resident outside of the area notified
to him/her.
c. The appointment of the Agent in the area mentioned in clause 2(a) shall not preclude the
Company from appointing any other person or persons to act as insurance Agent or Corporate
Agent of the Company in such area; nor shall such appointment abridge or derogate from the
obligations of the Agent under the terms & conditions laid down here.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 6
 d. The Company may, at its sole discretion, decide on the Insurance products for which the Agent
may solicit and procure proposals and to change, add or discontinue any such product at any
time.
e. Agency appointment may be refused to the applicant if he/she does not fulfill any of the
conditions prescribed for appointment of insurance agents.
f. An applicant aggrieved by the decision of refusal to grant agency appointment, may submit a
review application to VP – Channel Administration for review of the decision.

3. Obligations of the Agent:

During the tenure the Agent shall serve the Company as an Insurance Agent/POSP with all due and
proper diligence, act dutifully and in good faith, observe all instructions given by the Unit Manager or
generally by the Company to all it’s Insurance Agents/POSP, as to his activities as an Insurance
Agent/POSP of the Company, and use his best endeavors in the discharge of his obligations under these
terms and conditions.
a) Without prejudice to the generality of the foregoing and, in particular, the Agent shall fulfill such
minimum business requirements and persistency criteria as may be prescribed by the Company
from time to time, in the matter of procurement of new life insurance business, premium income,
number of lives to be assured, number of policies to be sold or in the matter of conversation and
preservation of business or in relation to policy- servicing. Agent’s appointment is liable for
termination for not meeting the requirements/criteria as may be defined and communicated by
the Company from time to time.
b) In order to satisfactorily discharge his obligations under these terms and conditions, the Agent
shall fully familiarize himself with all the insurance products offered for sale by the Company
including the rate of premium charged for each such product, and the policies and practices
followed by the Company in the matter of customer service and conservation of business.
c) The Agent shall not allow or offer to allow, either directly or indirectly, as an inducement to any
person to take out or renew or continue an insurance policy, any rebate of the whole or part of
the commission payable to him or otherwise, except as may be allowed under the Rules and
Regulations, of the premium shown on the policy.
d) The Agent shall familiarize himself with all the statutory requirements as may relate to the
discharge of his obligations as an Insurance Agent/POSP and shall fully conform to, comply with
and observe and follow such requirements and in the event of his/her failure to do so, the Agent
shall be personally liable for all consequences thereto and shall also indemnify the Company in
respect of any loss or injury caused to or suffered by it as a result of such failure.
e) The Code of Conduct as prescribed by Clause VIII of the IRDAI Guidelines on Appointment of
Insurance Agents/POSP, 2015 dated March 16, 2015 and/or as amended from time to time, any
statutory modification or substitution thereof and any Code of Conduct as prescribed by the
Company shall be deemed to have been set out in and be part of these terms and conditions. The
Agent shall scrupulously follow and comply with the same. The Code of Conduct is incorporated
in the letter of appointment issued to you by the Company.
f) Without prejudice to the generality of the obligations under Clause 3.5, and in particular the
Agent shall strictly observe, conform to and comply with the, requirements in relation to
customer service, insurance advertisements and on any matter relating to Insurance
Agents/POSP as prescribed by the Rules & Regulations for insurance agents, from time to time.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 7
 g) All communications and all information whether written, verbal or visual and all other material
supplied to or obtained by the Agent in the course of or as a result of the discharge of his
obligations under these terms and conditions and all information in relation to any particular
assurance obtained by him as Agent shall be treated by the Agent as confidential and shall not
be disclosed by him to any third party without prior written consent of the Company.
h) The Agent shall hold in trust for the company any application, report, form, security or other
property received by him in the course of his duties as the Agent of the Company and shall,
dispatch, makeover to the Company all such applications, reports, forms, securities or other
properties within twenty four hours of such receipt excluding public holidays. The Agent shall
not have the authority, either expressed or implied to receive any payment except the premium
towards proposal deposit from the public on behalf of the Company. If, however, the agent
receives any payment whatsoever, the same shall be remitted to the company within 24 hours
of its receipt. Under no circumstances, shall the payment made to the agent be deemed to
be a payment made to the Company.
i) The Agent shall attend all meetings, conventions, workshops or the like called for by the
Company and shall also observe, follow and comply with any directive or direction, issued by the
Company generally in relation to its insurance agents or with particular reference to the Agent.
j) The Agent shall keep true, full and correct records of all the transactions entered into by him as
Agent of the company, and if so required by the Company, furnish for its inspection (including
making of copies thereof) all or any such records, early.
k) During the continuance of his Agency, the Agent will engage in activities as an Insurance Agent
exclusively of the Company and not of any other insurer carrying on life insurance business or in
soliciting or selling of even other than insurance products or products, which are similar to or
identical to the insurance products of the Company. The Agent also undertakes not to have any
tie up with any other insurer as an employee or director or promoter and not to hold any
insurance activity related license or hold any position with any Corporate Agent/ Broker/ TPA /
Insurance Marketing Firm/ any other insurance intermediary.
l) The Agent has no authority to and shall not take part in any dispute or institute or defend any
proceedings or settle or attempt to settle or make any admission concerning any dispute,
proceeding or other claim relating to the business or affairs of the Company except with the prior
written permission of the Company.
m) If so required by the Company, the Agent shall open and maintain a bank account in his own
name (only) to which the Company may credit the commission, remuneration or reward or any
other amount due and payable to the Agent. All the expenses for opening and maintaining the
account shall be borne by the Agent.
n) The Agent shall indemnify and keep indemnified the Company against loss or injury or costs or
expenses suffered or incurred by the Company in consequence of any act or omission of the
Agent tantamounting to a breach of these terms and conditions.
o) Nothing in these terms and conditions or otherwise shall entitle the Agent to make any
representation or warranties on behalf of the Company or to enter into any contract or
agreement on behalf of the Company or bind the Company in any manner whatsoever by his/her
acts of commission or omission.
p) The Agent covenants with the Company that he is qualified to act as an Insurance Agent/POSP
under law and does not suffer any disqualification rendering invalid his appointment as Agent.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 8
 4. Remuneration:
As consideration for soliciting and procuring insurance business for the Company the Agent shall be paid
by way of commission / remuneration on such scale as may be notified by the Company from time to
time subject to IRDAI Regulations or Guidelines issued and/or the Company’s Board approved policy for
‘Appointment of Insurance Agents/POSP’.
The commission / remuneration shall be payable to the Agent only for life insurance business procured
by him which results in policies issued by the Company and not in respect of any incomplete or invalid
transaction or proposal.
Subject to the Rules and Regulations, The Act and the IRDA Act, the Company shall have absolute
freedom to revise the scale of commission in respect of one or more of the insurance products offered
for sale by the Company, provided that the Agent shall be given notice of not less than 30 days of such
revision through one or more methods of communication generally employed by the Company for
internal communication. The revised rates shall be made applicable p r o s p e c t i v e l y and shall not be
applicable to policies issued in pursuance of proposals already registered with the Company, unless
otherwise, stipulated by the Act, the IRDA Act or Rules and Regulations.
In the event of any change in the scale of commission, brought about by reason of
amendment/changes/issuance of the Rules and Regulations or the Act or the IRDA Act or the Company’s
Board approved policy for ‘Appointment of Insurance Agents’, the Company’s liability to pay commission
to the Agent in respect of any policies issued by it shall be limited to what is permissible under such law,
rules, regulations, order or directive.
The Agent shall not be entitled to any commission in respect of the sale of a policy effected through him
which is declared null and void by the Company for any reason or which has been cancelled for any
reason whatsoever.
Payment of commission or remuneration or reward to Insurance Agents/POSP shall be made as per the
Reward & Recognition schemes designed and approved by the Company from time to time with an
objective to appropriately incentivize high performance. The above payments will be subject to limits
prescribed as per extant applicable Guidelines/Regulations issued by IRDAI from time to time.
Where so ordered by a court of law or a statutory or other authority who is empowered by law to so
order, the Company may withhold or retain the commission or remuneration or reward or any other
amount due and payable to the Agent or to recover and remit to such court or statutory or other
authority the amount so ordered to be remitted.
All payments made to the Agent shall be subject to deduction of taxes as per the applicable tax laws.
The Company shall pay the standard renewal commission as prescribed in the product even in case of his
agency getting cancelled in accordance with the Company’s Board approved policy on ‘Appointment of
Insurance Agents’, provided the agent is eligible for such renewal commission as per the prevailing rules,
regulations and policies. However, the Company reserves the right to forfeit commission in certain cases
like fraud, forgery, misconduct, etc. on grounds of disciplinary action as approved by the disciplinary
authority of the Company.
In case of unfortunate event of death of an Agent, hereditary commission will continue to be paid to the
nominee or heirs of the Agent for so long as such commission would have been payable had the
Insurance Agent/POSP been alive, in accordance with the Company’s Board approved policy on
‘Appointment of Insurance Agents’ subject to the guidelines, rules and regulations of the IRDAI and the
Company.
The Company reserves the right to recover any commission, remuneration or reward paid wrongly, or in
excess of what is due and payable to the Agent from any amount due and payable to the Agent.
Without prejudice to the generality of what is stated in the above clause, the Company shall have the
absolute right to recover or retain from any amount due and payable to the Agent, any commission,
remuneration or reward paid to him under one or more of the following situations:

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 9
 a) Where any policy issued in pursuance of a proposal procured by the Agent is declared null and
void by the Company.
b) Where any cheque or other instrument tendered or any payment effected through the ECS or
similar mode of payment towards premium is dishonored or as the case may be reversed or
countermanded for any reason;
c) Where a policyholder cancels a policy by exercising the “Free Look Option”.
Explanation: For the purpose of this clause “Free Look Option” shall mean the option referred to
in sub regulation (2) of Regulation 6 of the Insurance Regulatory and Development Authority
(Protection of Policyholder’s Interest) Regulation 2002.
d) Where the Company has been directed to repay or refund any premium paid under a Policy on
account of any order, judgment or direction of any court, Tribunal, Consumer forum or Insurance
Ombudsman or where the Company is satisfied that such repayment or refund is in the best
interest of the Company.
e) If any Policy issued in pursuance of a proposal proceed by the Agent is allowed to lapse within
months of its issue
f) Where on a complaint by a Policyholder, the Company or, as the case may be, a court, tribunal or
other authority empowered by law to adjudicate the complaint, holds that the Policyholder has
been sold a Policy not opted for by him or under a plan of insurance different from or on terms
other than those agreed to by him, resulting in the cancellation of the Policy, the Company shall
be entitled to recover from the commission, remuneration or reward or any other amount due
and payable to the Agent, the commission paid to him in respect of that Policy, besides
withdrawing the credit of the business allotted to the Agent for any other purpose in relation to
the said Policy.

5. Suspension or Cancellation of Agency:

As per terms and conditions laid down here, Company holds the rights to suspend or cancel the
appointment in any of the following events:-
5.1 Suspension or cancellation of Appointment:
Appointment may be suspended or cancelled after due notice and after giving the Agent reasonable
opportunity of being heard:--
a) where the Agent does not hold a valid appointment letter;
b) where the appointment to act as an Insurance Agent/POSP issued to the agent is cancelled for
any reason; upon the death of the Agent;
c) where a petition to declare the Agent as an insolvent is presented to a court of competent
Jurisdiction;
d) where on account of any change in law the operation of these terms and conditions has become
unlawful;
e) where the Company is convinced that the Agent is guilty of an act involving moral turpitude and
that it would reflect poorly on the fair name or the conduct of affairs or of business of the
Company;

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 10
 f) where the Agent is convicted of an offence and sentenced to any term of imprisonment by a
court of competent jurisdiction.
Note: - The fact that the Agent has preferred an appeal against such conviction or sentence shall
not
derogate from the operation of this provision during the pendency of such appeal. Further that
the Agent has been acquitted in any proceeding or in any appeal initiated against him on a
compliant made to or by the Company shall not entitle him to claim any compensation or
damages against the Company
g) violates the provisions of the Insurance Act,1938, Insurance Regulatory and Development
Authority Act, 1999 or rules or regulations, made there under as amended from time to time;
h) attracts any of the disqualifications mentioned in Guidelines/Regulations issued by IRDAI
from time to time.
i) fails to comply with the code of conduct stipulated in the Company’s Policy for Appointment of
Insurance Agents/POSP and notified from time to time.
j) violates terms of appointment.
k) fails to furnish any information relating to his/her activities as an agent as required by the
Company or the Authority;
l) fails to comply with the directions issued by the Authority;
m) furnishes wrong or false information; or conceal or fail to disclose material facts in the
application submitted for appointment of Agent or during the period of its validity.
n) does not submit periodical returns as required by the Company/Authority;
o) does not co-operate with any inspection or enquiry conducted by the Authority;
p) fails to resolve the complaints of the policyholders or fails to give a satisfactory reply to the
Authority in this behalf;
q) On failure to perform any other duties or obligation lawfully required of him or under these terms
and conditions generally as an insurance Agent/POSP of the Company,
r) Where there is allegation of fraud, dishonesty or misdemeanor against the agent by any policy
holder of the Company or an officer or employees of the Company.
s) Further the Company shall also have the right to suspend/cancel the agency if the Company feels
that the continuation of the agency may be against the public interest.
Where the suspension / cancellation of the appointment of the Agent is being contemplated or is in
process, or pending enquiry into the allegations of fraud, misappropriations etc against the Agent, the
Company may, by notice in writing, direct the Agent not to procure business or to perform his functions
as the Agent of the Company for such period as may be specified. Any breach by the Agent of any such
direction shall, besides disentitling the Agent to any remuneration for any business brought in by him
during the period of operation of prohibition or for any other benefit pertaining to such business, also
be construed as a breach of this terms and conditions. W here, however, the Company does not initiate
or proceed with the termination, the Agent shall not be entitled to any compensation or damages on the
ground of loss of business or of profit or on any other ground whatsoever in respect of any such direction
as is referred to above against the Company.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 11
 5.2 Manner of holding enquiry before/after suspension of appointment of the Insurance Agent/POSP:
a. The appointment of an Insurance Agent/POSP shall be cancelled only after an enquiry has been
conducted in accordance with the procedure specified by Guidelines/Regulations issued by
IRDAI from time to time.
b. For the purpose of holding an enquiry, the Company may appoint an Officer as an Enquiry
Officer within 15 days of the issue of the suspension order;
c. The Enquiry Officer shall issue a show cause notice to the Insurance Agent/POSP at the
registered address of the insurance agent calling for all information / data as deemed necessary
to conduct the enquiry and grant the insurance agent/POSP a time of 21 days from date of
receipt of the show cause notice, for submission of his/her reply and such information / data
called for;
d. The insurance Agent/POSP may, within 21 days from the date of receipt of such notice, furnish
to the enquiry officer a reply to the Show cause notice together with copies of documentary or
other evidence relied on by him or sought by the Enquiry Officer;
e. The Enquiry Officer shall give a reasonable opportunity of hearing to the insurance Agent/POSP
to enable him to make submissions in support of his/her reply;
f. The Insurance Agent/POSP may either appear in person or through any person duly authorised
by him to present his case, provided however that the prior approval of the Company is obtained
for the appearance of the ‘Authorised Person’;
g. If it is considered necessary, the Enquiry Officer may require the Company to present its case
through one of its officers;
h. If it is considered necessary, the Enquiry Officer may call for feedback/information from any
other related entity during the course of enquiry;
i. If it is considered necessary, the Enquiry Officer may call for additional papers from the
Insurance Agent/POSP.
j. The Enquiry Officer shall make all necessary efforts to complete the proceeding at the earliest
but in no case beyond 45 days of the commencement of the enquiry:
k. Provided that in case the enquiry cannot be completed within the prescribed time limit of 45
days as mentioned in (10) above; the enquiry officer may seek additional time from the Company
stating the reason thereof;
l. The Enquiry Officer shall, after taking into account all relevant facts and submissions made by the
Insurance Agent/POSP, shall furnish a report making his/her recommendations to the
Designated Official. The Designated Official shall pass a final order in writing with reasons. The
order of designated official shall be signed and dated and communicated to the agent.

5.3 Procedure for Cancellation of Agency:

On the issue of the final order for cancellation of agency of the Insurance Agent/POSP, the agent shall
cease to act as an Insurance Agent/POSP from the date of the final order. Registration of new business
by the suspended/cancelled agent will be stopped.

5.4 Effect of suspension/cancellation of Agency appointment:

On and from the date of suspension or cancellation of the agency, the Insurance Agent/POSP, shall cease
to act as an Insurance Agent/POSP.
a) The Appointment letter and Identity card has to be submitted to the Company by the agent
whose appointment has been cancelled by the Company within 7 days of issuance of final order
effecting cancellation of appointment.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 12
 b) The Company shall black list the agent and enter the details of the agent whose appointment is
suspended/cancelled into the black listed agents database maintained by the Authority and the
centralized list of agents database maintained by the Authority, in online mode, immediately after
issuance of the order effecting suspension/cancellation. Further, the Company also reserves the
right to display the order of suspension/cancelation of appointment of Insurance Agent on its W
ebsite.
c) In case a suspension is revoked in respect of any agent on conclusion of disciplinary action by
way of issuance of a speaking order by Designated Official, the details of such agent shall be
removed from list of black listed Agents as soon as the Speaking Order revoking his/her
suspension is issued.
d) The Company shall also inform other insurers, Life or General or Health Insurer or mono line
insurer with whom he/she is acting as an agent, of the action taken against the Agent for their
records and necessary action.

5.5 Appeal Provision

On the issue of the final order for cancellation of agency of the Insurance Agent/POSP, the agent shall
cease to act as an Insurance Agent/POSP from the date of the final order. Registration of new business
by the suspended/cancelled agent will be stopped.

5.6 Procedure to be followed in respect of resignation/surrender of appointment by an Insurance

Agent/POSP:
a) In case an insurance agent appointed by the Company wishes to surrender his agency with the
Company, he/she shall surrender his appointment letter and identity card to the designated
official of the Company.
b) The Company shall issue the cessation certificate as detailed in Form 1-C within a period of 15
days from the date of resignation or surrender of appointment.
c) An agent who has surrendered his appointment may seek fresh appointment with other insurer.
In such a case, the agent has to furnish to the new insurer all the details of his/her previous
agency and produce Cessation Certificate issued by the previous insurer issued in Form I-C,
along with his agency application form.
d) Upon the cancellation of the Agency as per terms and conditions, the Agent shall not for a period
of ninety days thereafter solicit or procure, directly or indirectly, any life insurance business for
any other life insurance company or be engaged, in any manner, in any competing activity against
the Company.
Upon the cancellation of the Agency as per the terms and conditions, the Agent shall forthwith return to
the Company all materials (including printed materials) and stores belonging to the Company which are
in his possession or custody. On the neglect or failure of the Agent to do so, the Company shall be
entitled, without being accused of trespass, to enter any premises occupied by the Agent for the purpose
of recovering such materials and stores.
Upon the cancellation of the Agency as per terms and conditions, the Agent shall not in any manner
represent himself as the Agent of the Company.
Upon the cancellation of the Agency as per terms and conditions, the Company shall be at liberty to
publish notices of such cancellation in any newspaper or other publications or to communicate the same
together with the grounds for such cancellation to the policyholders, other offices and Agents of the
Company or to any other insurance Company or to the general public and of the fact that the Agent is
not empowered to act for or on behalf of the Company or bind or represent the Company in any manner
whatsoever.
Signature of the candidate
Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 13
 6. Agent not an employee:
Nothing in this terms and conditions shall imply or be construed to constitute the relationship between
the Company and the Agent as anything other than that of an insurer and Insurance Agent/POSP.
It shall not be open to the Agent to raise any claim of being an employee of the Company or for
preference in the matter of recruitment to the service of the Company.

7. MISCELL ANEOUS:
As per these terms and conditions, unless the context requires, words importing the singular shall
include the plural and vice-versa and words importing a gender shall include every gender and reference
to persons shall include bodies incorporate and unincorporated.
These terms and conditions shall be operative from the date of appointment of the agent and binding on
them.
No waiver, alteration, variation or addition to this laid terms and conditions shall be effective unless
made in writing on or after the date of appointment and / or otherwise accepted by the Agent and the
authorized representative of the Company.
The Company shall have a first lien upon all sums payable to the Agent in respect of any indebtedness of
the Agent to the Company. The Company is entitled to set off, adjust or otherwise recover from the
moneys due and payable to the Agent all such sums as are due to the Company, on account of such
indebtedness of the Agent, including any indebtedness arising out of breach of any covenants as per
terms and conditions on appointment of Agent.
The interpretation, construction and effect of any of the provisions of these terms and conditions on
appointment of Agent laid down by the Company and amended time to time shall be final and binding on
the Agent.
All notices, documents, consents, approvals or other communications (“Notice”) to be given hereunder
shall be in writing and shall be transmitted by registered post or by facsimile or other electronic means in
a form generating a record copy to the party being served at the relevant address for that party. Notice
sent by mail shall be deemed to have been duly served not later than four working days after the date of
posting. Any Notice sent by facsimile or other electronic means shall be deemed to have been duly
served at the time of transmission (if transmitted during normal business hours at the location of the
recipient and if not so transmitted then at the start of normal business hours on the next day which is a
business day for the company).
If any term or provision in these terms and conditions on appointment of Agent shall be held to be illegal
or unenforceable, in whole or in part, under any enactment or rule or law, such term or provision or part
shall to that extent be deemed not to form part of these terms and conditions but the validity and
enforceability of the remainder of these terms and conditions shall not be affected.
The waiver or forbearance or failure of the Company in any one or more instances upon the performance
of any provisions of these terms and conditions on appointment of agent shall not be construed as a
waiver or relinquishment of the Company’s rights and the Agent’s obligations in respect of due
performance of obligations shall continue in full force and effect.
The Agency shall be governed by all the related regulations, Acts and Statutes besides these terms and
conditions. These terms and conditions shall not substitute any of the statutory provisions but they are
in addition to the statutory provisions governing the appointment of Insurance Agents/POSP.
“I hereby agree to abide by the terms and conditions of Appointment as an Insurance Agent/POSP.”

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 14
 Declaration to be signed by the applicant
a) The information/details furnished herein are true to the best of my knowledge and belief. I
further declare that I have not suppressed or concealed any detail sought herein.
b) All the supporting documents submitted by me along with this application are genuine and true
and agree that they shall form a part of my application for agency.
c) I have not 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.
d) I have not been found guilty of or to have knowingly participated in or connived at any fraud,
dishonestly or mis-representation against an insurer or an insured in the course of any judicial
proceeding relation to any policy of insurance or the winding up of an insurance company or in
the course of an investigation of the affairs of an insurer
e) I undertake to inform SBI Life of any change in the above information.
f) I authorise the company to verify, check, investigate and share or reveal any or all the
information provided by me in this application to any other person or insurer or entity or
authority as the company may deem fit.
g) I hereby agree that if any information/details provided herein is found by the company to be
misstated or concealed, the company may take any action deemed fit, including but not limited
to denial of appointment as an agent and if subsequently detected after granting agency or
appointment as an Agent, initiate such penal actions which the company may deem fit which may
include, but not limited to, levy of Financial Penalty or Suspension / Cancellation of my
appointment.
h) I hereby give my voluntary consent to SBI Life Insurance Company Limited (SBI Life) and
authorize the Company to obtain necessary details like Name, DOB, Address, Mobile Number,
Email, Photograph through the copy of Aadhar card/QR code available on my Aadhar/XML file
shared using the offline verification process of UIDAI or Aadhar Number/Virtual ID, Name, Date
of Birth, Fingerprint/Iris and my Aadhar details used for authentication either through Yes/No
authentication facility or e-KYC facility in accordance with the Aadhar (Target Delivery of
Financial and other Subsidies , Benefits and Services) Act, 2016 and all other applicable
laws/regulations. I understand that this information shall be used by SBI Life only for KYC
purpose. I have duly been made aware that I can also use alternative KYC documents like
Passport, Voter’s Identity Card, Driving License, Identity Card with Applicant photograph issued
by State/Central Govt. Dept./Statutory/Regulatory Authorities, Public Sector Undertakings,
Scheduled Commercial Banks and Public Financial Institutions and other similar documents in
lieu of Aadhar for the purpose of completing my KYC formalities. I understand and agree that the
details so obtained shall be stored with SBI Life and shared solely for the purpose of carrying out
necessary due diligence for appointment as an Insurance Agent and to meet regulatory
requirement. Further I understand, my biometrics will not be stored/shared by SBI Life. I will not
hold SBI Life or any of its authorized officials responsible in case any incorrect information is
provided by me.
i) I hereby authorize SBI Life to provide/receive my details to/from banks, financial institutions,
third party service providers the company may have tie-ups with for verification of the
information provided by including the bank account provided by me for payment of commission.

Signature of the candidate

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 15
 j) I hereby give my consent to SBI Life to use my mobile number written/registered while writing
communication/permanent address for sending One Time Password (OTP) for authentication
purposes and I hereby agree and consent that the authentication through OTP verification will
be considered as my signature on the agency application form and there is no need for my
physical signatures on these documents once OTP based authentication is done.
k) I authorise SBI Life & its other related partners associated with Appointment of Insurance
Agent/POSP to use my mobile number & email id for sending alerts through SMS, WhatsApp,
email and letter for communication regarding appointment as an Insurance Agent and other
related communication
Conditions Applicable To Nomination
• A Nomination will not be effective unless it is communicated to SBI Life Insurance Co Ltd and
registered by SBI Life Insurance Co Ltd.
• Any change in Nomination shall be duly informed to SBI Life Insurance Co Ltd and registered by
it in its records. SBI Life Insurance Co Ltd shall not be liable in any manner whatsoever for
payment made to the registered nominees as per its records.
• By registering a nomination , SBI Life Insurance Co Ltd makes no admission and expresses no
opinion whatsoever as to the validity or effect of the nomination, it being understood that the
parties satisfy themselves as to the form of nomination and all other points relating to the
nomination before sending it to SBI Life Insurance Co Ltd .
• By registering a nomination, SBI Life Insurance Co Ltd does not Admit any liability for payment
of commission or any other sum in the event of death of the Insurance Advisor.
• The liability of SBI Life Insurance Co Ltd for payment of commission or any other sum in the
event of death of the Insurance Advisor would be determined solely by the fact of whether the
said Insurance Advisor is qualified for such payment in accordance with the laws in force in India
and the applicable regulations at the time of his/ her death.

Place: _______________________
Date: ________________________
(Signature of Applicant)
GENER AL INSTRUCTIONS & INFORM ATION:

• This form is not an application to IRDAI for an Agency License.

• The minimum education qualification required is Class X or equivalent examination from
recognized Board/Institution.
• UM/ BSM to verify all original documents and attest the copies submitted.
• All cancellations/alterations on the form to be countersigned by the applicant.
• In case of name change, documentary evidence in support thereof to be submitted.
• To ensure that details provided in application form match the documents submitted.
• Candidate has to sign every page of application form.
• Documents submitted should be seld attested by candidate.
• Affix your colour photograph on the application form.

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 16

 FOR OFFICE USE ONLY

Date of application received: Call for interview: YES NO

Checked by

Application Approved Rejected

Interviewed by:

I /W e hereby certify that I/W e have interviewed the candidate, have verified his identity and have
carried out adequate screening procedures and due diligence. I/W e have explained all the terms &
conditions of appointment of Insurance Agents issued by SBI Life Insurance Co. Ltd., IRDAI Guidelines
on Appointment of Insurance Agents, 2015 and amendments or Regulations if any, thereof.

UM Signature: BSM Signature:

UM Name: BSM Name:

Employee ID : Employee ID :

UM Code: Branch Name:

Mobile No Mobile No

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 17

 BSM Questionnaire

Agent Name : BSM Comments

PAN Number :

Q.1 Do you have any sales experience

Q.2 Do you have any insurance selling experience

Q.3 How you have been contacted by your UM

Q.4 What are your plans for your agency earnings

Q.5 For how many years you have been residing in this city

Declaration
I confirm that
(i) I have reviewed the application and verified the credentials of
the applicant and to the best of my knowledge the information
and documents provided are correct
(ii) All mandatory information has been submitted and all
supporting documents have been attested by the applicant
and verified with the originals by the Unit Manager
(iii) The applicant is currently not engaged as an employee
(permanent or contractual) or vendor / supplier of SBI Life.
Also, his spouse or any immediate family member is not an
employee of SBI Life.
(iv) I have interviewed the applicant and recommend appointing
him as an insurance agent of SBI Life

Authenticated By Name: BSM Code:

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 18

 FORM I - A
APPLICATION FOR APPOINTMENT TO ACT AS AN INSURANCE AGENT
(With a Life Insurer OR General Insurer OR Health Insurer)

To
SBI Life Insurance Company Limited Photograph
Corporate Office, Mumbai

Dear Sir,

I request that Appointment to act as an insurance agent of your organization may be granted to me.
I hereby declare that particulars given below are true and that the APPOINTMENT for which I apply will
be used only by myself for soliciting or procuring insurance business for your Insurance Organization
(1) Name:
(2) Title:
(3)Father's/Husband's Name:
(4) Full Address:
City/Village & Taluka: District:
State: Pin Code:

Mobile No.: Email Id:

(5) Date of Birth: D DMM Y Y Y Y Attach Age proof

(6) Educational Qualifications . (Tick the  right Box) (Attach self-attested certificate)
Class X /SSC Diploma (after 10th Std/ ITI) Class XII/HSC
Graduate Post Graduate/Professional Other (if applicable) :

(7) PAN CARD Number: (attach self-attested copy of the PAN CARD)
(8) Particulars of pass in pre-recruitment test conducted by the Insurance Institute of India. or any
Examination Body:

Name of Examination Body:

Candidate's Name:
Candidate's Number:

Centre of Examination

Name of the Exam Passed

Date of Passing D DMM Y Y Y Y

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 19

 (9) Furnish the details of any insurance agency in force or ever hold by the Applicant

Date of Date of
Agency code Appointment Reason for
Name of the Insurer cessation of
Number as agent cessation of agency
Agency
DD / M M / YYY Y DD / M M / YYY Y

DD / M M / YYY Y DD / M M / YYY Y

DD / M M / YYY Y DD / M M / YYY Y

DD / M M / YYY Y DD / M M / YYY Y

*Please attach A gen cy cessation letter issued by the insurer

(10) Details of other insurance related activities undertaken ,if any:

(11) I declare that

(d) I have not been found to be of unsound mind by a court of competent jurisdiction;
(e) I have not 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;
(f) I have not been found guilty of or to have knowingly participated in or connived at any fraud,
dishonestly or misrepresentation against an insurer or an insured.
Yours faithfully,
Place :
Date: D DMM Y Y Y Y Signature of applicant

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 20

 Notes and Instructions
1. The application should be filled in Hindi or English language.
2. Any correction or alteration made in any answer to the questions in the application should be
initialed by the applicant .
3. An applicant must beat least 18 years and above of age on the date of the applicati on. The applicant
shall furnish proof of age.
4. An applicant shall furnish the proof of pass in the pre-recruitment exam conducted by an examination
body duly recognized by the Insurance Regulatory and Development Authority of India.
5. The following documents should be attached with the application
(a) Proof of Age
(b) Educational Qualifications
(c) Proof of pass in the agency examination as mentioned above
(d) Copy of PAN Card
(e) Address proof to the satisfaction of the insurer

Application Form/Ver 3.0/Oct 24 For Internal Circulation Only Page 21