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Institute of Actuaries of India

Institute of Actuaries of India here

APPLICATION FORM FOR STUDENT MEMBERSHIP

N.B: Before completing this form the applicant should study the Instructions and Information given below. The
completed form should be lodged with the Institute at the below mentioned address only.

302, Indian Globe Chambers, 142, Fort Street, Off D N Road,

Near CST (VT) Station, Mumbai – 400001
Tel: 67843333 Ext. 301, Fax: 678443330
E-mail: education@actuariesindia.org

NOTES FOR APPLICANTS - Please Read Carefully

l Admission as a Student of Institute of Actuaries of India will normally be granted to an applicant who
meets the minimum entry standards prescribed in this application form (Please refer section 6)

Admission fees for student membership is as under :

Status Total Admission Fees

inclusive of subscription
upto March

Resident in India Rs. 1000/-

Resident outside India US $ 140/-

Note : a) Please send the fees by demand draft/pay order in favour of 'Institute of Actuaries of India’
payable at Mumbai. Demand Draft should not be stapled but attached with U pin.

b) During the financial year i.e. April to March, whenever the admission is taken, the subscription
will be applicable only for that financial year e.g.:- For admission taken on 2nd March 2010
subscription paid will be valid till 31st March 2010 and again subscription for 2010-2011 will be
due on 1st April 2010.

If you wish to appear for May 2010 examinations, the IAI should receive this application, together with
the necessary fee by the appropriate date shown below :
Examination Session Last date of receipt of Membership application:
May 2010 nd
2 Jan 2010
Nationality

So following information is Mandatory.

ADDRESS

City State Country

PERMANENT ADDRESS

City State Country

City State Country

Employer Code : Employee Designation :
E-mail ID
(Alternate Email ID)
 Are you a member of any other actuarial association ?
If so, please give the following information.
Name of the Institute Membership No. Membership Class

Residence

Permanent Address

Title of Percentage of
marks obtained in
Mathematics

Educational

Professional

N.B. 1) Please enclose attested true copies of educational certificates and mark sheets for all the examinations form 10+2
onwards. Please also attach proof of date of birth, Change in Name (if any) if the same is not included in any of these
documents. Documentary evidence is required for change in name.
2) Attestation should be done by class one officer in government organization or professionals, like C.A., ICWA, Gazzetted
Officer, Notary, Actuary, Bank Manager etc. Professionals should mention their Institutes Membership number.

/ Pay Order No. :

I apply for admission as a Student Member of Institute of Actuaries of India. If my application is approved I agree
to confirm to the Rules and Professional Conduct Standards of the Institute as they currently exist or as they may
in future be altered, amended or enlarged, and I will promote the objectives of the Institute to the best of my
ability. I understand that to withdraw from membership I must inform the Institute of my resignation and that after
payment of any arrears, return of books, papers or other property of the Institute, I will be free from these
obligations. I further declare that I have not applied earlier to the Institute for admission as a member.
Note : In case the applicant has earlier applied for admission as a member, the details of same should be
furnished including whether such admission was granted or denied.

enclosed certified copies of all educational / professional

including English qualification and proof of Date of Birth
enclosed the DD/Pay Order towards payment of Admission fees.

Please sign within box with black ink.

Date :

Date of
Admission
Membership
No.
 iii. Institute of Actuaries of Australia.

The photocopies should be attested by class one officer of a government organization or professionals,
like C.A., ICWA, Gazetted Officer, Notary, Actuary, Bank Manager etc. Professionals should mention
their Institutes Membership number.