AFF

IDAVIT

I, Davinder Kumar Garg S/o Sh. Dhaniram Garg R/O H.no. 244 Sector – 18 Faridabad , Haryana do hereby solemnly affirm and declare as under :

1. I declare that since the date of my last application for license.

a. I have not been found unsound mind by a Court of Competent jurisdiction.
b. I have not been found guilty of criminal misappropriation or criminal breach of trust or cheating or forgery of an abetment of or
attempt to commit any such offence by a Court of Competent jurisdiction, and
c. I have not been found guilty of or to have knowingly participate in or connived at any fraud/dishonesty or made any
misrepresentation against any insurer or insured in the course of any judicial proceeding relation to a policy of insurance or the
winding up of any investigation of the affairs of any insurer, and
d. My license has not been cancelled at any time by the controller of Insurance Regulatory and Development Authority.
e. I declare that continue to hold the qualification on the basis of which my license mentioned above was issued.
f. An undertaking on performance report showing survey work done by me during the last years of the validity period indicating total
number of survey work , and amount involved to each category of cases year-wise and company-wise is attached.
g. I am not engaged in any other occupation.
h. I have not been disqualified for any of the provisions neither attached the disqualification stated in section 42D of the Insurance Act,
1938.

Deponent

Verification

Verified that the content stated, above are true and correct to the best of my knowledge and belief and nothing has been concealed therein.

Verified at Faridabad on 10.04.2020 Deponent