B da 3im aster Bank of Baroda ater: diae110; | BCC:BR:111:323 04.07.2019 fera_aeit oi erates & fee afos CIRCULAR TO ALL BRANCHES/ OFFICES IN INDIA i ISSUED BY WEALTH MANAGEMENT SERVICES & DEMAT DEPARTMENT | faa Helew / Dear Sir, fae / Re: “Nomination for IRDAI IC 38 Certifications as Specified Person 1 Specified Person (SP) per Branch Our Bank is a Corporate Agent for distribution of insurance products of our various insurance tie-up partners. As per IRDAI Regulations only Specified Persons can solicit and source insurance business. An employee is called a Specified Person when he or she is IRDAI IC38 Certified We have been stating the importance and urgency of the SP Certification at every forum, as it is a regulatory requirement and compliance in nature. We endeavor to have at least 1 SP per Branch. With this agenda we are continuously requesting all the Zones / Regions to encourage Staff members for IRDA IC38 Certification We have also launched the n Dollar Round Table (MDRT) 2019 programme for our staff members and this program is exclusively for the staff members who are Specified Person. This is a great opportunity for all the Staff members to participate in the International Conference by becoming Specified Person and achieving the threshold target for MDRT. As per circular No. BCC:BR:108:367 dated 08/08/2016, this certification is a part of SPEED scheme wherein candidates are eligible for incentive of Rs 8000/ and reimbursement of course fees on successful completion of the certifications. The interested staff members can apply for this certification after taking necessary approval from the competent authority through HRnes. The staff members can submit the duly filled Nomination Forms to their respective Regional Office (RO) and the RO in tum will send the forms to Corporate Office. The RBDM / RMM of the concemed Region will collect and consolidate all the Nomination forms and dispatch it to our department. The ZBDM / ZMM of the Zone will coordinate with the Regions for ensuring that all the Nomination forms collected are dispatched to our Department Please avoid sending forms in ones or twos, It will be appreciated if the duly filled Nomination Forms are scanned and sent to us via e-mail before dispatching the original Nomination Forms. pel Wealth Management & Demat Dept Baroda Sun Tower, C- 34, G-Block, Bandra Kurla Complex, Bandra (E), Mumbai 400051, India ‘Tel, 022. 67592549, Fax: 022 - 6759 203,| wms.bcc@bankofbaroda.co,inB ad 3ifm aster Bank of Baroda We request all the RBDM/RMM to dispatch the forms along with required documents in the address mentioned below. Ritesh Kumar Mandal Chief Manager Wealth Management Services Bank of Baroda, Baroda Sun Tower, C- 34, G- Block, Bandra Kurla Complex Bandra (E), Mumbai - 400051 Please mention “IRDAI IC38 Nomination Form" on the top of the envelope and name of the Region on the back of the envelope | All Branches are requested to NOMINATE at least ONE staff member for | certification latest by 15!" July 2019, so that the complete certification process is over by 30" September 2019. We request all the Zones & Regions to encourage the staff members for this certification and ensure at least 1 Specified Person (SP) per Branch. The progress on this will be monitored on fortnightly basis. Yours faithfully, . (Purshotam) General Manager (Wealth Management Services & Demat) Wr Enclosed: Nomination Form for IRDAI IC38 Certification. \Wslth Manegement & Demat Dept Baroda Sun Tower, C- 34, G-Block, Bandra Kurla Complex, Bandra (E), Mumbai 400081, India Tol. 022- 67592549, Fax: 022 - 6759 2593,| wms.bcc@bankofbaroda.co.inEB; ap ails agar Bank of Baroda IRDAI C38 (Composite) Certification Photo Signature of Candidate Branch Sold ID: | Full Name of Branch / Office (BO/RO): | Full BranchiOffice Address “Town / Place:. State: District: . | PIN Code! Applicant's Name (BLOCK LETTERS) (As in Class XIl- Certificate): (Mr/ Ms / Mrs / Dr.) Father / Husband Name: Category: General SC ST OBC. URBAN. al »RURAL | PAN No (BLOCK LETTER: _ Aadhar No:.of Barod: Date of Birth ( dd/mm/yyyy): Sex: Male / Female Details of Basic Qualification: Class XII /or equivalent : Name of the Board (Class XII) | Roll No. for Class Xi! Board Exam: DATE, MONTH and Year of Passing: (DD/MM/YYYY). | Educational Qualification ( Tick the applicable qualifications) a)insurance Qualification: (V whatever is applicable) | )Associate/Fellow of Institute of Actuaries of India | ii)Associate/Fellow of Cll London | iiAssociate/Fellow of Insurance Institute of India | iv)Post Graduate Qualification of Institute of insurance and Risk Management Hyderabad v) Not Applicable b)Graduate- B.Com/ BA/ BSC/ M.Com ¢) Post Graduate: M/A/ M.Sc! MBA/M CA/ICWA/ BE Primary Profession: Banking T Mobile No! I J Email ID (BLOCK LETTERS)... Employee Code No| Present Address : ( BLOCK LETTERS) House/Flat Number:. | Street IRoad .......... fk as cee | | Land Mark, TowniCity State District pin code LI]| Permanent Address : (BLOCK LETTERS) | House/Flat Number:.. ~ | Street /Road Land Mark..... TownlCity: ........ State District Pin Code IMPORTANT: | Mandatory self-attested copies of the following documents required with this form. 1. PAN CARD 2. Aadhar Card 3. 12" Std Passing Board Certificate 4. Degree / Certificate of Highest Qualification ( No mark sheet) | 5. Recent Passport Photo to be pasted on the TOP of this Form. | | confirm that all the details are correct to the best of my knowledge and belief. | Signature of Employee | Name | Designation. Place | Date. E-mail id ; | Contact No. Mobile... » Land line.......... Recommended by Signature : Name of RM/DRM: Date: =