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 vkosnu i= 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) http://imaxauto.in/agent/application Page 1/2 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) http://imaxauto.in/agent/application Page 2/2