FORM - IRDA - 3 - AF
[See Regulation 4]
APPLICATION FROM A FIRM OR COMPANY FOR A LICENCE TO ACT AS A SURVEYOR AND LOSS ASSESSOR

Checklist
Please ensure the following:
1) To enclose a copy of the Membership certificate issued by the Institute to directors/partners.
2) To make online payment of fees (as mentioned in the regulations) through “Net Banking” during application submission.
3) Have scanned copies ready of Degree/ Diploma /Technical qualifications attested by Notary/ Magistrate only.
4) To attach scanned copy of affidavit duly Notarized against S.No. 2 of the application form.
5) Attach attested and scanned copies of documents wherever required.
6) Send Self addressed envelop 4.5”X10” with Rs.40 postage stamp to IRDA.
Notes: Read with Regulation 4
1. The attention of the applicant is drawn to Section 102 of the Insurance Act 1938, which provides that whoever in any document required for the purpose of any of the provisions of the Act, rules or regulations made there under, fails to furnish the same, shall be liable to a penalty not exceeding Rs 5 lakhs for each such failure and punishable with fine.
2. A firm or company including group companies can apply for only one licence which will entitle it to act as a surveyor and loss assessor.
3. Any correction or alteration made in the application should be initialed by the applicant.
4. Name of the company should be suffixed by "Insurance Surveyor and Loss Assessor".
5. A licensed SLA cannot act/function as a Director/Partner of more than one company/firm.
6. All directors shall possess surveyor license which shall be duly licensed and be a member of the Institute.
7. The main object of the company/firm shall be to undertake survey, loss assessments and related jobs.
8. Any changes in license details should be duly reported within 15 days to IRDA for grant of modified license. Affidavit should be provided on behalf of the firm.
9. The fee to be applied depends on the highest level of membership of any of the Director/Partner of the company/Firm.
10. An affidavit of Rs. 10/- duly notarized on non-judicial stamp paper is required to be scanned and attached for renewal of licenses in the form of a declaration as contained against Sl.No.6 of the application form.
11. An email notification will be sent to the applicant on successful submission of the application form.
12. Any change in the information submitted to the authority must be informed to the authority within 15 days from date of the change.
It is requested that a license to act as a Surveyor and Loss Assessor may be granted to our Firm/ Company for the following departments and level of membership allotted to our directors/partners under their individual surveyor license:
Dept
Fire
Marine cargo
Marine Hull
Engg
Motor
Misc
Crop Insurance
LOP
Name of director/partners, their individual License-Details & level of Membership
It is hereby declared that- (i) No director/ partner of our Company/ Firm has been found to be of unsound mind by a Court of competent jurisdiction. (ii) No director/ partner of our Company/ Firm has 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. (iii) No director/ partner of our Company/ Firm has been found guilty of or to have knowingly participated in or connived at any fraud, dishonesty or misrepresentation against an insurer or an insured in the course of any judicial proceedings relating 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 insurers. (iv) No director/ partner of our Company/ Firm is a minor. (v) No director/ partner of our Company/ Firm shall violate the code of conduct specified by the regulations made by the Authority. (vi) All director(s)/ partner(s) of our Company/ Firm possess the requisite qualifications
and practical training as specified by the regulations made by the Authority. (vii) All director(s)/ partner(s) persons of our Company/ Firm have passed such examination as specified by the regulations made by the Authority.
(The above declaration shall pre-populate in the online licensing process)
It is also declared that the particulars given below are true.
1. Name of Firm/Company (In English & Hindi) ……………………….
2. Address of Company/Firm (In English & Hindi) ………………………. (Registered/Corporate Office) ……………………….
3. Details of Branch Office/s (If any) ……………………….. ………………………..
………………………..
4. Details of Employees
Licensed surveyors employed in the firm
License no & Level of membership
Designation
Employment Period
SLA No.
Date of Expiry
From Date
To Date
It is also declared that the name of all the director/s & partner(s) with their addresses and their date of birth submitted:
a) have been in practice as a surveyor/ loss assessor on the 31st May,1970 or;
b) hold a degree of a recognized university in any branch of engineering, or
c) be a fellow or associate member of the Institute of Chartered Accountants of India or Institute of Cost and Works Accountants of India or
d) possess actuarial qualifications or hold a degree or diploma of any Indian University or Institute in relation to insurance, or
e) hold a diploma in insurance granted or recognized by the Government, or
f) possess any of the technical qualifications mentioned in Rule 56A
(N.B. 1: In the case of each of the partners/directors claiming to come under item (a) above and not being eligible to come under any of the items (b) to (f) above, a declaration as given in the Insurance Rules, 1939 and sworn before a Magistrate or Notary Public should be forwarded and in the case of each of the partners/Directors claiming to come under any one of the items (b) to
(f) above, either the original diplomas/ certificates with one of the attested copy each, or copies of the original diplomas/ certificates duly attested by a Magistrate or Notary Public should be enclosed. Where original diplomas/ certificates are sent, they will be returned after perusal, but no responsibility can be accepted for loss or damage of such originals
5. Details of Directors (details to capture multiple directors is captured)
SLA No. ……………………..
Membership details of Institute:
Membership/ ID card No ----------------
Date of Issue of ID card ---------------
Level of membership allotted ……………
Date of Expiry ……………………..
Name ……………………..
Address ……………………..
Departments allocated
Dept
Fire
Marine cargo
Marine Hull
Engg
Motor
Misc
Crop Insurance
LOP
Level of Membership
Last Employment details
Name of Employer
Nature of Organization
Nature of Work
Period of employment
From Date
To Date
(Govt./Semi-govt/Private Firm, insurance company, surveyor firm, PSU, others)
(Insurance survey related, Others)
N.B. : Where a director/ partner does not already hold an individual license then an application (in FORM NO. 1-AF - Application for New License) from such a person should also submitted.) Did the Firm/Company ever hold a license? If Yes, provide details below and upload copy of old license
SLA No. ……………………..
Date of Issue ……………………..
Date of expiry ……………………..
Reason for Non renewal ……………………..
Fee Payment: Net Banking /Demand Draft/NEFT/RTGS
Fee applicable for all Surveyor categories
Highest level of membership of any of the Director/Partner of the company/Firm
Amount payable by individuals surveyor and Loss Assessor
Fellow Member
25000
Associate Member
20000
Licentiate Member
15000
Declaration
I solemnly declare and confirm that the particulars given above are true to the best of my knowledge and belief.
Signature of Applicant…………………………………………..