Individuals  Corporates     Professionals
Home Glossary SiteMap Contact Us
  My Bima E-Agent Policies Surveyors Careers
    Login
   Home  >   Professionals  >  Agents Registration  

Dear Agent,

Welcome to the Privileged Agents' Club on our site. Please provide the following details to complete the enlistment and note that the fields marked with * symbol are mandatory.


Personal Details
Login ID*
Password*
(min. of 3 characters)
Retype Password*
Name*
Address*
City/Town*
State
Pincode*
Telephone
   (std)       (Number)
-
-
Fax
(Please provide genuine E-Mail to help us activate your Bima account)
E-mail*
Date of Birth *
(DD/MM/YYYY)
Licence No*
Licence Expire Date*
(DD/MM/YYYY)
Educational Qualification
Insurance Qualification

Companies You are attached to(Atleast one company in either categories)
Life
Address*
 
City/Town*
State*
Pincode
Telephone -
Fax
General
Address*
 
City/Town*
State*
Pincode
Telephone -
Fax
Working as an Agent since*
(DD/MM/YYYY)

Area of Specialization(Atleast in one category)
Life
Life
Non-Life
All General Insurances
Motor Health Property
Travel House holders Marine
Mediclaim Shopkeepers Professional indemnity
Your fulltime occupation

Details of Insurance Training Undergone
Institute
Course
Training Period
Course Contents

Business History (Last Three years)
Life Insurance
  Year No.of Life's Sum Assured  
   
   
   
General Insurance
  Year Class of business Premium  
   
   
   

Achievements
Any other Particulars/Achievements

Clear     Submit



Policies  |  Compare Policies  |  MyBima  |  E-mail  |  E-Agent  |  Careers  |  Premium Calculator  |  Personal Finance  |  Tax Planner  |  Surveyors  |  Bonus Calculator  |  Agents Search  |  BookPoint  |  Insurers  |  Message Board  |  Basics  |  Site Map  |  Contact Us  |  Articles  |  ProposalForms  |  NewKids  |  Bimaonline in News  |  Tips  |  GuestBook  |  FAQs |  NRI Center |  Greetings  |  News Updates  |  Events  |  Debate Corner  |  Bima Stats | Insurance Rules  |  Bima Fun  |  Glossary  |  Insurance Guide  |  Consumer Corner  |  Home
DISCLAIMER Copyright © 2000-03. Bimaonline.com All rights reserved