FORM-IRDA-18
Reg [4(1)(xi)]
APPLICATION FORMAT FOR GRANT OF MODIFIED LICENSE CORPORATE SURVEYOR

Important Instructions:
Any change in the information submitted to the authority must be informed to the authority within 15 days from date of the change, attach copies of documents as proof.
Select Modification Type
Name
Name of Firm/Company ………………………….
Remarks ……………………………..
Corporate License No………… Expiry date……….
Corporate/Registered Office Address :
Address 1: ………………………
Address 2: ………………………
Address 3: ………………………
City/Town/Village : ………
District: ………………………….
State: …………………..
Country:………………
Pin code: ………………
Remarks:……………………….
o Branch Office Address :
Select Branch Pune Satara` Nasik
Address 1: ………………………
Address 2: ………………………
Address 3: ………………………
City/Town/Village : ………
District: ………………………….
State: …………………..
Country:………………
Pin code: ………………
Remarks:……………………….
Change in Director/Partner Details :
Add new Director/Partner Remove existing Director/Partner
Modify existing Director/Partner
Change in employee :
Add new employee/s Remove existing employee/s
Change in Share holding pattern and Promoter(s)
Correction in the license already issued (where there is a typrographical error in the license issued):
Change in the level of Membership allotted by the Institute to the director(s)/partner(s)
From ……… To……….( Attach soft copy of Membership certificate issued by the Institute indicating such change/s and reasons thereof)
Opening of branch offices/any other office by corporate surveyor
Change in Personal information :
Phone No.(Res) …………………
Phone No. (Office): ………………..
Mobile No. ……………………
e-mail: ………………………………
Alternate e-mail: …………………………….
Remarks: ………………………………………………………………..
Signature of the director/partner
Seal of the company
Date:
Place: