National Insurance Academy |Exam Registration

EXAMINATION REGISTRATION FORM

Exam Date 16-06-2023

Welcome to the Examination Registration Form! We appreciate you taking the time to provide us with the information we need. Please read the following instructions carefully before filling out the form:

Required fields are marked with an asterisk (*). Please make sure to fill them out completely.
Once you verify your email address, you will be redirected to a detailed registration form to fill in more details.
Once you have completed the form, you will be redirected to make the payments for the examination.
If your payments are successful, you will be notified with your registration details through email.
Please make sure to check your spam or junk folder in case it goes there.
Please note that all information you provide will be kept confidential and used only for the purposes stated in the form.

Thank you for your cooperation!

Exam Registration

Name of the Candidate *

PAN Number(User Id) *

Email ID *

Click on Send OTP button to verify email

Verify OTP. *

Resend OTP

Name of the candidate *

Gender *

Date of Birth *

Address *

Pin Code *

Mobile Number *

Telephone *

Email ID *

PAN Number(User Id) *

State *

Verify your personal details given above. It will be required by you for download of your Admit Card, Score Card etc.

Details of your Company

Name of the Company *

Address

State *

Pin Code

Contact Person Name

Phone Number

Email ID

Professional Qualification*

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

Professional Qualification

No of Hours Training undergone :

Training ID *

Date of Completion * (Training from 17-06-2022 is eligible)

Have you appeared earlier for the exam *

No. of Attempts *

Details of Training Institute *

Examination Centre *

Applied for *

Broking Module Opted for *

Do you have insurance background *

Examination Fess : Rs. 2500/- & GST (18%) : Rs. 450/-
Total Fees Charged : Rs. 2950/-

Please Upload Photo *

Your photograph in jpeg format, file size below 30 kb. File name should be given as your?Name_PAN Number ?(e.g. PriyankaDeshmukh_AJCPK1122R.jpg)

Upload Certificate : *

Upload your valid Brokers Training Completion certificate (Fresh) in pdf format, file size below 100KB. File name should be given as your Name_PAN Number (e.g. PriyankaDeshmukh_AJCPK1122R.pdf)

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