ANNEXURE ‘A’ FORMAT OF APPLICATION FOR SENIOR BUSINESS ASSOCIATE Affix your recent Passport size Photograph here 4. Name in full (In English: Capital letters, Surname first) i f + a 2A. Mother tongue: 2. Male/Femal 3. Mailing address (Please do not repeat name): if TT TPIN No Cc Telephone Nos. with STD Code: a) Office: c) Residential: fe b) Mobile No: ) E-mail id: 5. Date of Birth ‘Age in completed years as on 1.4.2009 6. Name of the Divisional Office: 7. Branch Name & Code: 8. S.R. No. 8A: Dev. Officer Code: 9. Date of Appointment: 10. Date of Confirmation: 11. Educational Qualification: __11 A: Technical Qualification:12. Are you keeping Own Office SOLELY for LIC Business: IF yes, Full Address of your Office: PINNo Whether the premises is Rental/Leased/Own: 13. Details of infrastructure available in your Office (e.g. Internet Connection/ Computers/ Counter/Seating Arrangement etc.): 14, Performance during last 3 years: L ‘Appraisal No of | Scheduled] Cost [Total | No of Club Mombor No of |Noof Roof Year | Policies First Year | Ratio | No ot | Agents- Cot! | New RLY remium | % | Agent [BM [DM] ZM ] OM Porporatal TOT agents eath (Rs in Lacs} s | Agent Recruited|Claim ' hereby declare that all statements made in this application are true and correct to the best of my knowledge and belief. | understand that in the event of any information being found false or incorrect or not satislying the prescribed eligibility criteria for Senior Business Associate, my candidature is liable to be cancelled rejected at any stage of selection. Place: Date: {Signature of the Applicant) For Branch use: 1. Details given by the applicant verified. 2. Recommendations of Chief/Sr./Branch Manager: Signature of Chief/Sr./Branch Manager (with seal)ANNEXURE - ‘B* REPORT OF INSPECTION OF OFFICE OF DEVELOPMENT OFFICER FOR SELECTION AS A SENIOR BUSINESS ASSOCIATE (1) Name (2) Development officer Code Number: (3) S.R.N (4) Address ~ (With Pin Code) Office: Residence: (5) Mobile No: (6) Branch: (7) Division: (8) Whether the Development officer has: * His own office: * A computer: Desktop/Laptop: * A printer: * Internet connectivity - Broadband or otherwise: (9) Whether the office is owned premises or rented: (10) The area of the Office: $q. ft (11) Whether the Office premises is situated in Market Place: (12) Whether the Office is easily accessible to customers. (13) Whether the Office is solely utilized for the purpose of life insurance business: (14) Any Other Observation: (15) Recommendations: (REPORTING OFFICER)