How to Apply i

How to Apply
i-Max Auto Insurance is recruting agents. To apply for said you have to fill the
application form given with this prospectus. Application form should be
send To “Director I-Max Auto Insurance, B-5 Ganga Vihar, Chinhat,
Lucknow-227105” by speed post/registered post.
Processing Fees/Security
Fees/Security Deposit
1000/- Processing fee (Non refundable) through Demand Draft/
Multycity Cheque in favour of Singh Business Solutions.
2000/- security Deposit through Demand Draft/ Multycity Cheque in
favour of Singh Business Solutions Payable at Lucknow.
Instructions:
Application form should be filled by black ball pen.
The application form should be fill by the applicant in his own
handwritting.
Affix a recent colour passport size photo.
Documents to enclosed with Application form:
1) 4 recent colour passport size photo.
2) Address Proof (photo copy)
3) I.D Proof (photo copy)
4) Pancard (photo copy)
5) Two Demand Draft/ Multycity Cheque in favoer of Singh
Business Solutions Payable at Lucknow.
APPLICATION FORM
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01- Name (In Block Letter) (uke cM+s v{kjksa esas) :.....................................................................................................................................
Recent Passport
uohure ikliksVZ
Size Photograph
02- Father's/Husband's Name (firk@ifr dk uke):..............................................................................................................................
lkbt QksVks
03- Permanent Address (LFkk;h irk):............................................................................................................................................
………………………………………………….………………………………………………………………………………..
……………………………………………………………………………………………………………………………..……
……………………………………………………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………………………………………………….…
04- Mailing Address (i= O;ogkj dk irk) :......................................................................................................................................................
..........................................................................................................................................................................................................................
...........................................................................................................................................................................................................................
05- Date of Birth (tUe frfFk): ...........................................................................................................................................................................
06- Nationality (jk”Vh;rk) :.................................................................................................................................................................................
07- Whether belongs to GEN/OBC/ SC/ST (;fn lkekU; tkfr@vuqlwfpr tkfr@vuqlwfpr tutkfr@vU; fiNM+k oxZ vUrxZr vkrs gks):
....................................................................................................................................................................................................................................
08- Educational/Professional/Technical Qualifications(‘kS{kf.kd@O;kolkf;d@rduhfd ;ksX;rk):Examination/
Degree/Diploma
(fMyksek@fMxzh@ijh{kk)
Board/University
(cksMZ@;wuholVhZ)
Year of Passing
(mrhZ.k gksus dk o”kZ)
Subjects
(fo”k;)
Division/Percentage
of Marks
(Js.kh@vadks dk izfr’kr)
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09- Details of Experience, if any (vuqHko dk fooj.k] ;fn dksbZ gks):
Name & Address of
Designation/ Post
Period
Reason for Leaving
Organisation
(inuke)
(vof/k)
(NksMus+ dk dkj.k)
(laLFkk@laxBu dk uke o irk)
From
To
(ls)
(rd)
10- Bank Draft No./Cheque No. (cSad M¶V ua0/psd ua0) .................................................................. Amount(jkf’k) …………………………...
11- Mobile No………………………………………………………………………Email Id………………………………………………………………….
DECLARATION
(?kks”k.kk)
I (EkSa) .............................................................................Son/Daughter/Wife of (iq=@iq=h@iRuh).................................................................
..................................................................................................................................................................................................................................
hereby declare that all the statements made above are complete and correct to the best of my knowledge and
belief. In the event of any information found false or incorrect action may be taken against me and I shall abide by
the decision of the i-Max Auto Insurance.
;g ?kks”k.kk djrk gw¡@djrh gw¡ fd esjs }kjk fn;s x;s lHkh dFku esjs laKku esa iw.kZ ,oa lR; gSaA ;fn esjs }kjk nh x;h dksbZ Hkh tkudkjh vlR; ;k xyr ikbZ tkrh
gS rks esjs fo:) dk;Zokgh dh tk ldrh gSA EkSa i-Max Auto Insurance dk fu.kZ; ekuus ds fy;s ck/; jgw¡xkA
Date (fnukad) :……………………
Place (LFkku) :…………….………
Signature of the Applicant
(vkosnd ds gLrk{kj)
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