National Insurance Academy

registration form

Online Course for Insurance Brokers

Welcome to our Online Course for Insurance Brokers! 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 selected module.
If your payments are successful, you will be enrolled in the system for the selected module and you will be notified with your credentials 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!

Renewal 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 *

Date of Birth *

Address *

Pin Code *

Mobile Number*

Telephone *

Email ID *

PAN Number(User Id) *

Sponsorship Details *

Name of the Company

Address

State *

Pin Code *

Contact Person Name

Phone Number

Email ID

Please select Qualification for eligibility of 25 hours training *

Are you carrying any Reinsurance related activity ?

Are you a principal underwriter for last 7 years ?

Are you an Insurance Consultant for a continuous period of 7 years ?

Have you held the position of a Manager in any one of the nationalized insurance companies in India ?

Eligible for :

Required Hours :

Professional Qualification

Broking Module Opted for *

Payment Amount : Rs.2006.00/- ( Renewal Course Registration : Rs. 1700/- + 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 Certificate : *

Upload your Brokers' Exam Passing certificate and renewal certificate in pdf format,file size below 100KB. File name should be given as your PAN Number_Name_degree (e.g. AJCPK1122R_PriyankaDeshmukh_degree.pdf)

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