F060520190232

Checklist of attachments (Use for Branch only)

1. Address Proof Yes No 6. NEFT/ECS Mandate Yes No
2. Age proof Yes No 7. Cancel cheque or passbook / Bank Statement Yes No
or Stamp
3. Pan Card / Acknowledgement Yes No 8. 1 photograph and signature Yes No
4. Education proof Yes No 9. Signature on the MPC declaration Yes No
5. IC Form other insurers Yes No 10 DD / Cash Yes No
.

DD details: DD no: DD Date DD_amount .

BANK Drawn on

DD / CASH Receipt details: Receipt no: . Amount .

Type of Application
1. Fresh case Yes 2. Composite case No
3. Life to Life case No 4. Employee Case No

Total Pages 12

FORM 1A
APPLICATION FOR APPOINTMENT TO ACT AS AN INSURANCE AGENT
(with a Life insurer OR General insurer OR Health insurer)
DEAR SIRS
I request that Appointment to act as an insurance agent of your insurance company may be granted to me.

I hereby declare that particulars given below are true and that the APPOINTMENT for which I apply will be used only
by myself for soliciting or procuring insurance business for your Insurance Company

(1) First Name S A N D H I Y A

Last Name R
Full Name S A N D H I Y A R
(As per Bank Account)
(2) Title: State 1 if are Mr., 2.Mrs., 3.Miss: M R S .
(3) Father's/Husband's Name: S U R E S H
(4) Full Address:(Attach proof for below mentioned address)
House/Flat No. 5 8 / A 2
Street/Town S A G A Y A N A G A R

District TIRUVANNAMALAI Pin Code: 606601 State: TAMIL NADU

Mobile: 8 3 1 0 4 3 5 7 6 8
Telephone No(R):
Email: S A N D H I Y A S U R E S H 1 2 1 @ G M A I L . C O M
I Understand and agree that all the future communication from HDFC Life will be e-mode and on the above mentioned mobile no. or Email ID
(5) Date of Birth(Attached age Proof) 3 0 - 0 8 - 1 9 9 5

(6) Age in completed years 23

(7) Educational Qualifications.(Attach self attested certificate) CLASS X

(8) PAN CARD Number(Attach self attested copy of the PAN CARD) H C M P S 5 3 3 2 E

(OR) PAN Acknowledgement Number

(9) Aadhar No: 4 0 0 7 7 7 8 7 1 3 0 3
(10) Particular of pass in pre-recuirement test conducted by the insurance institute of india or any examination body:
Name of Examination Body
Candidate's name:
Candidate's Number:
Centre of Examination
Name of the Exam passed
Date of passing
(11) Furnish the details of any insurance agency in force or ever hold by the applicant:

Name of the insurer Agency code number Date of Appoinment as agent Date of cessation of agency Reason of cessation agency

*Please attach Agency cessation letter issued by the insurer

(12) Details of other insurance related activities appointment / undertaken, if any :_________________________
Name of Examination Body
(13) I declare that---
(a) I have not been found to be of unsound mind by a court of competent jurisdiction;
(b) I have not been found guilty of criminal misapproproation or criminal breach of trust or cheating or forgery or an abetment of or attempts to commit any
such offence by a court of competent jurisdiction;
(c) I have not been found guility of or to have knowingly participated or connived at any fraud dishonestly or mis-representation against an insurser or an
insured.
(d) I have not violated the code of conduct specified under clause 7 of the IRDAI(Appointment of insurance agents) Guidelines, 2015.***Applicable only
for L2Ltransfer & Composite.
Place : yours faithfully

Date :
signature of applicant
Notes and Instruction
1.The application should be filled only in english or hindi language.
2.Any correction or alteration made in any answer to the questions in the application should be initialled by the applicant.
3.An applicant must be at least 18 years of age on the date of the application. The applicant shall furnish proof of age.
4.An applicant shall furnish the proof of pass in the pre-recruitment exam conducted by the insurance institude of india ,Mumbai or an examniation body
approved by insurance Regulatory and Development Authority of india.
Please fill Form 1B , If you are applying for composite Insurance agent
FORM -1-B
APPLICATION OF AN EXISTING INSURANCE AGENT FOR APPOINTMENT TO ACT AS COMPOSITE INSURANCE AGENT
WITH ANOTHER INSURER(LIFE OR GENERAL OR HEALTH INSURANCE OR MONO-LINE INSURANCE)
NAME OF THE INSURANCE AGENT_________________________

Details of the insurance agency held(Past & Present)

Name of the insurer Agency code number Date of Appoinment as agent Date of cessation of agency Reason of cessation agency

Note If Agency is currently in-force with an insurer mention "INFORCE" in the column Date of cessation of agency

COMPOSITE INSURANCE AGENCY APPOINTMENT now being sought with

Life Insurance Company H D F C L i f e
General insurance Company
Health insurance Company
other Mono-Line insurance Company
**Mention name of the insurance company in the box above
Note:(1)No person shall act as an insurance agent for more than one life insurer,one general insurer,one health insurer and one of each of other mono-line
insurers(2)Any person who acts as an insurance agent in contravention of this act , shall be liable to a penalty which may extend to ten thousands rupess,(3)attach
separate Application Form for each of the Insurance Organisation with whom you seek to obtain Appointment and submit all the application forms to yours
current insurer only.
yours faithfully
Place:
Date : signature of applicant
CANDIDATE DETAILS:

1. Gender: FEMALE

2. Category: GENERAL
3. Maiden Name: S A N D H I Y A R
(Only for married females) First Name Middle Name Surname

4. Martial Status: MARRIED

5. Nationality: INDIAN

6. Location: URBAN

7. Roll no: 694391 Institution: DEPARTMENT OF GOVERNMENT OF TAMIL NADU Year Of passing: 26-05-2010

8. Occupation: HOUSEWIFE

9. Previous Industry experience: NIL

10. Previous Sales experience: NIL

11. If married,details of spouse: SELF EMPLOYED

12. Family Income: 4 TO 6 LACS

13. Training Type: OFFLINE

14. Exam Information

Exam Centre: NSEIT LIMITED - BANGALORE Examination Language: ENGLISH Exam Institute: NSEIT

15. Are you interested in our Financial Consultant Career Programme(FCCP)? NO

(FCCP is a program that gives you an opportunity to join as an sales employee.please contact your Circle Head for details)
16. Are you a 'Politically Exposed Person'?

Please answer Yes or No NO

*Politically exposed persons are individuals who are or have been entrusted with prominent public functions in a foreign country,their family members and
of government/judicial/military officers,Senior executives of state owned corporations,important politically party officials etc.
17. Nomination details:To be filled mandatorily
Name of Nominee: S U R E S H
Name of Guardian:
(If Nominee is a minor)
Relationship of Nominee: S U R E S H
Address of Nominee: 1 7 5 V E N K A T A S WA M Y L A Y O U T R A Y A S A N D R A V
.
.
Declaration in lieu of PAN card copy

I SANDHIYA R residing at 58/A258/A2 do hereby declare that I am applying for appointment as a Financial Consultant of

procuring agency under application number

understand that I am required to submit a copy of the Permanent Account Number (PAN)card.However, currently I do not have PAN and have applied for the
same vide Form No. 49A under Section 139A of the Income-tax Act, 1961. I also hereby attach the certifiedtrue copy of Form 49A.I Understand that i would not
be appointed to act as an Insurance Agent as specified in IRDAI Guidelines on Appointment of Insurance Agent,2015 unless I submit my PAN card to HDFC
Life.I hereby undertake to submit the PAN number to HDFC Life within 15 working days of the receipt of the same from the authority.I further declare that what
is slated above is true and in the event it is found to be incorrect,then I take complete responsibility for the consequences
Declaration

(a) 'Are you related to any current employee of HDFC Life?' No

* Name of the employee related to
* Describe Relationship:
(The definition of Relative is “spouse, sisters, brothers, parents, sons, daughters, daughter-in-law, son-in-law)
If you are related to any of the above mentioned relations, then appointment letter will not be issued.
I hereby confirm that apart from the relations as mention below. I do not have any personal relationship with any employee of HDFC Life.
(b) I understand that HDFC Life shall communicate with me in connection with the agency, and any such communication will not be classified as “Commercial Communication”
under the TRAI regulations. I hereby agree to indemnify, defend and hold harmless HDFC Life and its employees, respective directors, and assigns against any liability or
loss that may occur due to complaints registered by me with TRAI for receiving calls from or on behalf of HDFC Life.
(c) As required under the IRDAI Guidelines on Appointment of Insurance Agent, 2015, the Financial Consultant of the Company is not entitled to become or remain a director
of any lnsurance Company. Further the Financial Consultant is not entitled to hold any other relationship with any life insurance Company in respect of any insurance activities
such as Broker, Corporate agent, Specified person, Referral etc. The appointment shall remain valid as per the governing laws.
I declare that I am not bound by any contractual obligation [eg. employment contracts etc.] that forbid/restrict me from entering into this agency agreement.
I undertake to indemnify HDFC Life for any damages/claims/expenses arising out of any false representation of misrepresentation.
I hereby declare that I am residing in India and that the information contained in this application is true and correct to the best of my knowledge and belief.
I undertake to inform HDFC Life of any change in my residence/office address as and when such change occurs. I accept and acknowledge that HDFC Life reserves the right
to reject this application without providing any reason. I authorize the company to verify I check / investigate and share or reveal to any other person or authority as the HDFC
Life may deem fit, any or all of the information provided in this application. I understand that the fees paid hereunder in non refundable. I hereby agree to indemnify HDFC
Life, if any statement / information, made / given by me / us to you or any other person are inaccurate or false or are found to be inaccurate or false. I understand that I will be
bound by the terms and conditions of the appointment letter issued to me, subject to me becoming eligible for the same. I also agree to indemnify HDFC Life .against any Tax
Liability which may arise, in case the declaration furnished by me is erroneous
I hereby declare that:
I will provide information as and when required by HDFC Life, acting on its own or under any order or instruction received from Statutory Authorities, as regards utilizations or
withdrawals of my commissions. I agree to HDFC Life providing any information related to me as available to the company at any time, to any Statutory Authority in relation
to the laws governing prevention of money laundering , applicable in the country. I understand that HDFC Life classifies its Financial Consultants under various categories of
risk for the purpose of complying with the laws governing prevention of money laundering and I confirm that I do not have any objections for the same.
I understand that HDFC Life has the right to peruse my financial profile and also agree that HDFC Life has right to cancel my appointment in case I have been found guilty of
any violation of the provisions of any Law, directly or indirectly, having relation to the laws governing prevention of money laundering.
Pan/Acknowledgement of Pan is mandatory requirement for appointment of Financial Consultant.

Place

Date Signature of the applicant

FC4
 MONEY PLUS BENEFIT CARD DECLARATION

Name
PAN CARD Number

OR PAN Acknowledgement Number

Part I- Guidelines on usage of Money Plus Benefit Card

A) The Money Plus Benefit Card (“Card”) is valid for a period of 5 years from the date of embossing. The validity period is mentioned on the Card plastics.

B) The balance on the Card cannot exceed Rs 50,000 at any given point of time.

C) Card shall be reloaded subject to the available balance on the Card.

D) Card can only be used for purchases at Visa merchant outlets in India, where EDC / POS terminals are installed for receiving payments through
Debit /Credit /Prepaid Cards and cash withdrawal is not allowed on the Card.

E) Card can be used at only HDFC Bank ATMs for Balance Enquiry.

F) In case the Card is misplaced/stolen or otherwise lost you are required to immediately report it to HDFC Bank by calling up Phone Banking for hotlisting
the lost Card and intimate HDFC Life at RR Helpdesk regarding the same with a written application for re issuance of fresh card. However, the Card will be
hotlisted by the Bank only during the working hours on a working day following the receipt of such intimation or 24 hours whichever is earlier. Amount
misused shall not be added or returned to the Card by HDFC Bank nor shall be added or returned by HDFC Life.

G) HDFC Bank reserves the right to vary the features of the Card as may be required by any governmental, statutory or regulatory requirements as may be
in force from time to time.

H) The Bank shall provide Net access to you to track the card transactions, balance enquiry etc.,however online shopping is not permitted.

Part II - Declaration by Financial Consultant

I hereby

A) I Accept that HDFC Bank is entitled in its absolute discretion to accept or reject any application made by HDFC Life for issuance of Card without assigning
any reason whatsoever,

B) Agree that I have read and understood and agree to abide by these terms & conditions of use of Card. I will be bound by the said Terms & Conditions as
maybe in force from time to time and use Card will be deemed to be acceptance of these Terms & Conditions,

C) agree that HDFC Bank may debit my account for service charges / fee as applicable from time to time,

D) will keep HDFC Life/HDFC Bank informed about any change in my details as mentioned in this form or as changed by me from time to time,

E) agree to indemnify HDFC Life and shall keep HDFC Life indemnified and harmless at all times, against any direct loss or damage suffered by HDFC Life
due to any act of commission or omission by me in relation to the Card, including, without limitation, any fraud or fraudulent cash out by me, any breach of
any of the terms and conditions herein appearing and/ or any breach of any statutory or regulatory guidelines relating to the use of Card,

F) Agree that the usage and safety of the Card is my responsibility, and any loss/misuse of the same is not the responsibility of HDFC Life/HDFC Bank. I shall
be responsible for all transactions processed by use of Card, whether or not processed with my knowledge or authority, express or implied. I shall accept
HDFC LifeI/HDFC Bank’s record of transactions as conclusive and binding for all purposes,

G) Understand that EDC / POS terminals are machines and errors could occur while in operation. Neither HDFC Life nor HDFC Bank is not responsible for
any such machine / mechanical errors / failures,

H) Agree and understand that HDFC Life and HDFC Bank shall not be liable for any loss by the misuse of the card, before the hotlisting was reported.
Amount misused shall not be added or returned to the Card by HDFC Bank nor shall be added or returned by HDFC Life,

I) agree to ensure that the Card is kept in safe custody and will not be handed over to anyone including anyone who claims to represent HDFC Bank.
I understand that neither HDFC Bank nor HDFC Life shall be responsible for any misuse of the card by virtue of the same falling into wrong hands,

J) In case a wrong entry has been debited to the Card, I will immediately raise the issue with HDFC Life to be taken up with HDFC Bank. The findings will be
binding on me,

K) understand that no fraud or zero liability claim will be entertained by HDFC Bank/HDFC Life,

L) If asked by the tax authorities or other regulatory authorities, HDFC Bank will furnish the Cardholder, Purchaser and card usage details to them,

M) Agree and accept that HDFC Life reserves the right of deactivation of card upon termination of agency/revocation, suspension and transfer of appointment,

N) Agree and accept that HDFC Life reserves the right to call for documents, if required, and I agree to furnish them within prescribed timelines.

Place

Date Signature of the applicant

 k
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FC6
 MANDATE FOR AVAILING NEFT/ECS FACILITY FOR COMMISSION PAYMENT F !"#
!"#$%&"'$&()*+,(#'$#-./,(0$%&.&1'!$2*)'+$&()1&1*1&-(3
(In terms of FORM No. E-5)

D D M M Y Y Y Y
ECS NEFT Date:

GENERAL DETAILS
!"#$%!&'!()*#*+)#,!-&*./,0#*0!1#.!23&4)5%5!)*!06%!7#*8!3%+&35.9

!:;%*+<!-&5%!1&*,<!)'!06%!(-!).!#,3%#5<!#..&+)#0%5!=)06!>?(-!@)'%9

4,(5$,##-*(1$!'1,&%)

:9!! "#$%!&'!06%!A#*8!

A9! :++&/*0!"/$7%3!!
(As appearing on the cheque book)

-9! "#$%!&'!06%!7#*8!73#*+6!

Address

Telephone No.

?9! B(C-!-D?E! (11-Digit code number of the bank and branch)

E9! FB-G!"&H! (9-Digit code number of the bank and branch)

(9!! I<2%!&'!06%!#++&/*0!1D*,<!0)+8!06%!+&33%+0!&*%9
Savings Current Cash Credit / Overdraft

G) Ledger and Ledger folio number

1B*!,)%/!&'!06%!7#*8!+%30)J+#0%!0&!7%!&70#)*%5!#.!/*5%3K!2,%#.%!#00#+6!#!7,#*8!+#*+%,,%5!+6%L/%!&3!26&0&+&2<!&'!#!+6%L/%!'&3!4%3)J+#0)&*!&'!06%!#7&4%!2#30)+/,#3.9

DECLARATION

1. I/We hereby declare that the particulars given above are correct and complete and no blanks have been left. If the transaction is delayed or not effected at all or
the credit is given to an incorrect account for reason of incomplete or incorrect information provided here, I/We would not hold HDFC Life Insurance Company
Limited or any of its associated a gents responsible.
2. I/We further undertake to refund any amount credited to my account either in excess or which is not due to me/us, at anytime due to any reason. whether by HDFC
Life or not.
3. I/We agree that the commission will be credited starting from the date that occurs after the date of this Mandate unless the Mandate is revoked and issuance of
relevant credit instruction from HDFC Life into the aforesaid account will be a valid discharge to HDFC Life.
4. ,MN%!'/306%3!+&*J3$!06#0!BMN%!/*5%3.0#*5!06).!$&5%!#.!#!$%06&5!&'!2#<$%*0!)*03&5/+%5!7<!G%.%34%!A#*8!&'!B*5)#K!=6)+6!23&4)5%.!/.!#*!&20)&*!0&!+&,,%+0!&/3
commissions, as and when they become due directly through our bank accounts.
OH BMN%!'/306%3!+&*J3$!06#0!BMN%!/*5%3.0#*5K!>?(-!@)'%!.6#,,!#++&$2,).6!06).!7<!)../)*;!06%!P#<$%*0!)*.03/+0)&*!%,%+03&*)+#,,<!063&/;6!)0.!7#*8%3!,#;%*0!0&!06%!-,%#3)*;
:/06&3)0<!#*5!06%!-,%#3)*;!:/06&3)0<!=&/,5!%*./3%!+3%5)0!0&!&/3!.2%+)J%5!7#*8!#++&/*0H
6. I/We further undertake to inform HDFC Life with an advance notice of 6 weeks, in case, l/We desire to change our bank details, due to any reason. However, HDFC
Life shall retain the right to accept this or reject the same in case the revised bank details are not enabled under this NEFT framework.
7. I/We further undertake to inform HDFC Life with an advance notice of 6 weeks, incase l/we decide to withdraw from this mode of payment.
8. By Furnishing this mandate, l/We revoke any mandate issued earlier for receiving credit of the commissions.

____________________________
Signature of Account Holder(s)

Credit that the Bank Account Details. the Name of the Account Holder and the signatures furnished are correct as per our record.

C);*#0/3%!&'!:/06&3)Q%5!D'J+)#,MA#*8!73#*+6!F#*#;%3!'3&$!06%!1-/.0&$%3.9!! A#*8!.0#$2!#*5!5#0%

!6789:9;<=>!10&!7%!J,,%5!)*!+#.%!&'!$).$#0+6!)*!*#$%9

B!6#4%!#22,)%5!'&3!#*!#22&)*0$%*0!=)06!>?(-!@)'%!#.!J*#*+)#,!+&*./,0#*0!)*!06e name of ________________________________________________________. I declare

that my name mentioned on the agency application form & the documents is _____________________________________________________________, whereas the
name mentioned on my bank account is __________________________________________________________. I hereby declare that both these names belong to me.

I shall indemnify HDFC Life and keep them free from any claims, damages, penalties, costs, charges, levies whatsoever due to the representation done above by me.

Signature :
Date :

FC7
 To be filled by HDFC Life Sales Team
HDFC life Branch Name: BANGALORE - M.G. ROAD Branch code : 015

Source of Recruitment: Personal Network Referring Agent Code/Referring Employee/Branch Code:

I, SURESHA R hereby declare that the applicant is not a relative of any HDFC Life employee.
(FLS Name)

Reporting Agency code : 00800479 Reporting Agency Signature:

FC Profile Analysis

S.No Criteria Score Score Earned

0 1 2 3 4
1 Marital Status - Single - Married/Separat - 3
ed/
Widowed/Divor
ced

2 Age <30 years 31-34 years 35 - 50 years >50 years - 0

3 Occupation Student Service Self employed/ Housewife/Retir Financial 3

govt/private unemployed ed Distributor/CA/ICWA/
CS/CFP*

4 Gender - Male Female - - 2

5 Educational Qualification - Undergraduate/ Graduate/ Post - - 1

Class X/Class Graduate/ MBA/CA
XII

6 Family Income <2 lakhs 2-4 lakhs 4-6 lakhs > 6 lakhs - 2

Total Score 11
^ Certificate required
* Attach document proof

Annual Premium Potential: 1-3 Lakhs

I have personally verified above document and details.

ACH / CH Name Signature

Note: If reporting ACH/CH is not available, signature is required from an equivalent designated or higher designated employee
 !"#$%&'()*$#+,-

!"#$%&%'()*+ +()$%(,%-..(+) #!)

This is with reference to your application for appointment as a life insurance agent with HDFC Life Company that are in your possession, to the Company. Upon termination of agency you shall
Insurance Company Ltd., (hereinafter referred to as /012% '3456789:% /;*,'% <=>29:% /?29). Your cease to represent yourself as the Company’s agent or use the Company’s name or logo
!!"#$%&'$%( )#%*( +,-.( /#0'( )#11( 2'( 3"$45&'6( "$( #778 $3'( "0( $( !!"#$%&'$%( 1'%%'5( 9/-553=704270% (directly or indirectly or by reference) in any manner whatsoever.
<2002@9) by HDFC Life, pursuant to your compliance with the Guidelines for Appointment of Insurance iii. In the event of the agency being terminated within a period of 24 months from the date of
Agents, 2015 issued by Insurance Regulatory and Development Authority of India (hereinafter referred to appointment, the Company shall be entitled to claim the entire costs incurred towards training
as /+"*-+9). The Terms & Conditions mentioned herein is applicable to you subject to your appointment you. The Company reserves the right to determine the extent of costs incurred as aforesaid.
as Financial Consultant of HDFC Life. On issuance of Appointment Letter by HDFC Life the below
#DB( N$<($"%#3'(%"(2'(7'5D'6(*'5'8$6'5(7* 11(2'(78043#'$%1<(7'5D'6("$(%*'(."&! $<G(#0(7'5D'6(2<
mentioned Terms & Conditions are deemed to be accepted by you.
@'A#7%'5'6(O"7%( %(#%7(@'A#7%'5'6(P043'G( $6(7* 11(2'(78043#'$%1<(7'5D'6("$(<"8(#0(7'$%(%"(<"8
:*'(2'1")(&'$%#"$'6(:'5&7(;(."$6#%#"$7(7* 11( !!1<(%"( 11(%5 $7 3%#"$97=(2'%)''$(87( 7(& <(2'(7!'3#4'6( by Registered Post/courier/email at the address mentioned hereinabove or at your last known
from time to time by the Company in addition to the relevant laws of India, in general, and in particular to address.
the provisions of the Insurance Act, 1938, and the Insurance Regulatory and Development Authority Act,
v. Any dispute arising within the terms of this Appointment Letter shall be subject to the jurisdiction
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of the Courts at Mumbai.
-A% APPOINTMENT OF FINANCIAL CONSULTANT [FC]B
!A% COMMISSIONS AND PAYMENTS
Your appointment as the Company’s Financial Consultant to source business from anywhere in India
i. !"#$%&'()*#+,--#'(*#.%&&,//,%)#0%#*%1#0!2%13!#"4'(*&")0#&%5"#%)-*#,6"6#7$89:7; 6
is at all times subject to your adhering to and in accordance with the terms and conditions of your $%&&,//,%)/#/!(--#<"#'(,5#=%2#'%-,.,"/#/%12."5#<*#*%1>#+!,.!#!(?"#<"")#,)#=%2."#=%2#(#'"2,%5#%=#
appointment and complying with the relevant guidelines/ regulations. Further your appointment is 0+")0*4=,?"9=%20*#5(*/#=2%&#0!"#5(0"#%=#,//1()."6# !"#'(*&")0#.*.-"#+,--#<"#5".,5"5#<*#0!"#$%&'()*#
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Section 42(3) of the Insurance Act, 1938 read with relevant IRDAI rules, regulations, guidelines & $%&'()*#=%2#=2(15>#@1(-,0*#%=#<1/,)"//#"0.6
circulars, as issued/ amended from time to time. ii. $%&&,//,%)#/!(--#<"#'(,5#,)#A)5,()#B1'""/#%)-*6
CA% DIRECTORSHIPS%D%( ;!"%+)$E"-)'!%-' +F+ GB
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As required under the Guidelines on Appointment of Insurance Agents, 2015, the Financial 0!"#2(0"/#()5#&%5"/#%=#'(*&")0#%=#.%&&,//,%)>#+,--#<"#,)=%2&"5#0%#*%1#<*#0!"#$%&'()*#=2%&#0,&"#0%#
Consultant of the Company is not entitled to become or remain a director of any Insurance Company. 0,&"6
Further the Financial Consultant is not entitled to hold any other relationship with any life insurance
iv. A)#.(/"#%=#0"2&,)(0,%)#%=#(3").*>#.%&&,//,%)#'(*(<-"#C,=#()*D#+,--#<"#&(5"#,)#(..%25()."#+,0!#0!"##
."&! $<(#$(5'7!'3%("0( $<(#$785 $3'( 3%#D#%#'7(783*( 7(E5"F'5G(."5!"5 %'( A'$%G(H!'3#4'6(!'57"$G( $%&'()*E/##'%-,.*>#+!,.!#+,--#<"#1'5(0"5#%)#$%&'()*E/#'%20(-#=2%&#0,&"#0%#0,&"
Referral etc.
v. $%&&,//,%)#/!(--#<"#/1<F".0#0%#5"51.0,%)/#%=#0(G#1)5"2#0!"#'2%?,/,%)#%=#A).%&"# (G#H.0>#IJKI#()5#()*#
'A% INDEMNITY %0!"2#(''-,.(<-"#-(+>#(/#(&")5"5#=2%&#0,&"#0%#0,&"6
i. The relationship between HDFC Life and the Financial Consultant shall be solely that of
vi. L10#%=#0!"#0%0(-#M%%5/#N#8"2?,."/# (G#CM8 D#-,(<,-,0*#%)#0!"#.%&&,//,%)/>#(#'%20,%)#%=#M8 >#(/#
principal and agent in relation to the insurance business/ policies. You agree and acknowledge &101(--*#(32""5#=2%&#0,&"#0%#0,&">#+,--#<"#<%2)"#<*#0!"#$%&'()*#()5#0!"#<(-()."#'%20,%)#%=#M8 #+,--#
%* %( %*'( 2'$'4%( "0( %*'( 5'1 %#"$7*#!( )#%*( $<( 'I#7%#$A( 387%"&'5J( !"1#3<*"16'5( H/.3I=J813IK2@9) <"#<%2)"#<*#*%1#()5#+,--#<"#(5F1/0"5#(3(,)/0#0!"#.%&&,//,%)#'(*%10/6# !"#2(0,%#(/#&101(--*#(32""5#
introduced by you belongs to HDFC Life and you shall not do anything following termination of =2%&#0,&"#0%#0,&"#=%2#/!(2,)3#%=#M8 #(/#&")0,%)"5#(<%?"#/!(--#<"#5,/'-(*"5#%)#0!"#$%&'()*E/#'%20(-#
this Agreement, or otherwise, to prejudice the continuing relationship between HDFC Life and $%)/1-0()0#$%2)"2#(/#(#2"(5*#2"="2")."#()5#0!"#5"0(,-/#%=#0!"#/(,5#5"51.0,%)#/!(--#(-/%#<"#
.%&&1),.(0"5#0%#*%1#0!2%13!#*%12#.%&&,//,%)#/0(0"&")06#
the Policyholder .
ii. You shall perform activities only to the extent and subject to the terms and conditions as vii. $%&&,//,%)#%)#2"51."5#'2"&,1&/#()5#'2"&,1&/#)%0#.%--".0"5#51"#0%O
,4$!"@1"#<%1)."
authorized by HDFC Life in writing. You shall be solely & personally liable for all acts which ,,4$()."--(0,%)##%=#2,5"2/##N#P%-,.,"/#,).-15,)3##0!%/"##5%)"##512,)3##0!"#;2""#-%%Q4,)4P"2,%5>
are not approved or authorized by the Company in writing or due to your default, negligence or ,,,4:%)#R,/.-%/12"#.()."--(0,%)/#
unlawful act or omission. You agree to indemnify and hold the Company and its representatives, /!(--#<"#5"51.0"5#=2%&#0!"#.%&&,//,%)#'(*(<-"#0%#*%16#
"043'57G( A'$%7( $6( 77#A$7(9K@'!5'7'$% %#D'7L=(* 5&1'77( %( 11(%#&'7(05"&( $6( A #$7%( $<( $6
viii. P%-,.*#.()."--(0,%)/#%2#<1/,)"//#2"?"2/(-/#,),0,(0"5#51"#0%#.1/0%&"2#.%&'-(,)0/#+,--#-"(5#2".-(,&9
all liability, damages, losses, claims, cost and expenses (including any fees and expenses) and 2".%?"2*#%=#.%&&,//,%)/#()5#<")"=,0/#'(,5#%10#0%#*%16# !,/#.-(1/"#/!(--#/12?,?"#0!"#0"2&,)(0,%)#%=#0!,/#
any other loss that may occur or arise due to your acts or omissions which are not approved or H''%,)0&")0#S"00"26
authorized by HDFC Life in writing or due to your default, negligence or unlawful act or omission.
ix. !"#$%&'()*#&(*#.!(23"#()#(&%1)0#=%2#.%&'-"0,)3#0!"#(''%,)0&")0#'2%."//#C,).-15,)3#02(,),)3D#(0#
iii. You agree to indemnify and hold the Company and its Representatives harmless from and 0!"#0,&"#%=#(''-*,)3#=%2#-,="#,)/12()."#(3").*6
against any and all liability, damages, losses, claims, cost and expenses (including any fees
and expenses) and any other loss that may occur or arise from or relate to breach of any of the ,A% #+)+#E#%CE$+)!$$%$ -)*-"*$%&%"!LE+"!#!) $%()%.!"$+$ !)'G
obligations undertaken by you or your representatives, including but not limited to instances
i. You shall maintain Persistency Rate and Minimum Business Standards as communicated by the
wherein such loss/ damage is caused due to any negligent act, omission, willful misconduct or
Company from time to time.
misrepresentation.
ii. You shall maintain a correct and complete record of the various policies sold and their
iv. You agree to indemnify, defend and hold harmless HDFC Life and its Representatives against
persistency on a year on year basis.
any liability or loss that may occur due to complaints registered by you and against you with
TRAI for receiving/ making calls from or on behalf of HDFC Life. iii. Non adherence to Persistency Rate and Minimum Business Standards will lead to withholding/
5'3"D'5<( "0( 3"&&#77#"$7( $6( 2'$'4%7( ! #6( %"( <"8B( Q%( & <( 17"( 1' 6( %"( %'5&#$ %#"$( "0( <"85
*A% TERMINATION/ SUSPENSION OF THE AGEN'GB
agency.
i. Your appointment as a Financial Consultant of the Company shall be valid until terminated by
MA% CE$+)!$$%."-' +'!%
either party as per terms and conditions of this Appointment Letter. Notwithstanding anything
contained in this Appointment Letter the Company is entitled to terminate the agency and your The Company is committed to high standards of legality and business ethics. It is a condition of this
appointment in accordance with the guidelines issued by IRDAI from time to time, without any appointment as well as of the continued relationship that you will in sourcing of policies observe
liability for compensation or damages in the below mentioned circumstances: high levels of legality and business ethics. Notwithstanding the termination clause if you breach the
business ethics, this Appointment Letter will stand terminated, in accordance with the guidelines
(a) Your performance has not been satisfactory as per Company’s policy; or
issued by IRDAI from time to time. You will strictly comply with all laws, rules, regulations and
(b) Violation or non compliance with statutory/ regulatory norms; or guidelines of IRDAI.
(c) You have acted in breach of the code of conduct; or All communications with/ to you will be in electronic form (email / sms/ company portal) at the email/
(d) Violation of the terms and conditions of your appointment; or mobile registered with the Company/ informed to you.
(e) Any information furnished by you in relation with the appointment is false, misleading, ;A% CODE OF CONDUCT
incorrect or untrue; or +%A% G(E%$;-<<:
(f) Acted in a fraudulent manner; or a. identify yourself as an insurance agent of the Company, to all the prospective policyholders/
9A=( M"8(* D'( (@'1 %#D'()"5F#$A( 7( $('&!1"<''()#%*(%*'(."&! $<B(:*'(6'4$#%#"$("0(@'1 %#D'( customers (hereinafter referred to as /.@3N52J0HNO9);
is “spouse, dependent children or dependent step children, whether residing with you or b. show the identity card issued by the Company to the Prospect, and also disclose the
not”; or agency appointment letter to the Prospect on demand;
(h) Failure to furnish any information/ books of accounts relating to your activities as an agent c. disseminate the correct and requisite information in respect of insurance products
as required by the Company or IRDAI; or offered for sale by the Company and take into account the needs of the Prospect while
(i) Failure to comply with the directions issued by IRDAI; or recommending the products;
(j) Provided wrong or false information; or concealed or failed to disclose material facts in the d. disclose the scales of commission in respect of the insurance product offered for sale, if
application submitted for appointment; or asked by the Prospect;
(k) Failure to submit periodical returns as required by the Insurer/IRDAI; or e. indicate the premium to be charged by the Company for the insurance product offered for
(l) Non co-operation with any inspection or enquiry conducted by IRDAI; or sale;
(m) Failure to resolve the complaints of the Policyholders or fails to give a satisfactory reply to f. explain to the Prospect the nature of information required in the proposal form by the
IRDAI in this behalf; or Company, and also the importance of disclosure of material information in the purchase
of an insurance product and shall discourage suppression of any information which is
(n) Performance of any act (individually or as a part of group) which is against the Company or
relevant to the Company for the purpose of underwriting;
is for defaming the Company or any of its employees/ business associates; or
g. bring to the notice of the Company any adverse habits or income inconsistencies of
(o) Your behavior in a discourteous manner with any Prospect/ Policyholder or with the
the Prospect, in the form of a report (hereinafter referred to as /,=767J=6I% '37NPI0670%
Company / any of its Representatives.
ii. Upon termination of agency you shall forthwith surrender the appointment letter and identity
card as well as all other manuals, tables, rate books, literatures, product guides etc. of the

___________________________________
Signature of Applicant
FC9
 !"#$%"&'()* +%,!-&.) along with every proposal submitted to the Company, and any e. resort to multilevel marketing for soliciting and procuring insurance policies and/or induct any
material fact that may adversely affect the underwriting decision of the Company as regards Prospect/Policyholder to join a multilevel level marketing scheme;
acceptance of the proposal, by making all reasonable enquiries about the Prospect; f. inform Customer about any investigation or reporting done under AML, if known to you.
h. !"#$%&"'(&)(*+$,$"(&- .+/(%",&#"&"'(&"$/(& 0&12$%3&"'(&4) 4 ,#2&0 )/&5$"'&"'(&6 /4#%78 g. behave in a discourteous manner with the Prospect/ Policyholder or with the Company / any of
and other documents subsequently asked for by the Company for completion of the its Representatives;
proposal; h. interfere with any products/proposals/business transactions introduced by any other insurance
i. inform promptly to the Prospect about the acceptance or rejection of the proposal by the agent;
Company; i. offer different rates, advantages, terms and conditions other than those offered by the Company;
j. advise every Prospect to effect nomination or assignment or change of address or exercise j. provide any misleading/ wrong information to the Policyholder related to AML;
of options, as the case may be, and offer necessary assistance in this behalf, wherever
C:& -(/#%-& )&)(.($>(&#&,'#)(& 0&.2#$/&4) .((-,&0) /&"'(&!(%(1.$#)7&+%-()&#%&$%,+)#%.(&. %")#."&
necessary;
or offer any share payable out of the commission which may be received by you from the
k. )(%-()&%(.(,,#)7&#,,$,"#%.(&" &"'(&9 2$.7' 2-()& )&.2#$/#%",& )&!(%(1.$#)$(,&$%&. /427$%3 Company.;
with the requirements for settlement of claims by the Company;
l. force, persuade or induce a Prospect/Policyholder to terminate any existing policy and to effect
l. make every attempt to ensure remittance of the premiums by the Prospect/ Policyholder a new proposal from him within three years from the date of such termination of the earlier
within the stipulated time, by giving notice to the Prospect/ Policyholder orally and in writing policy;
with a view to conserve the insurance business already procured by you.
m. apply for fresh agency appointment to act as an insurance agent, if your agency appointment
m. If collects a premium on a policy of insurance on behalf of an insurer, you will deposit with, 5#,&(#)2$()&.#%.(22(-&!7&"'(&-(,$3%#"(-& 01.$#2B&#%-&#&4()$ -& 0&1>(&7(#),&'#,&% "&(2#4,(-&0) /
or dispatch by post to, the insurer, the premium so collected in full without deduction of your the date of such cancellation;
commission within twenty-four hours of the collections excluding bank and postal holidays.
n. become or remain a director of any insurance Company;
n. observe and adhere and also bring the same to the notice of the Prospect/ Policyholder the
o. induce any Prospect/ Policyholder into accepting any product, which the Prospect/ Policyholder
provisions of Section 41 of the Insurance Act, 1938.
did not initially need, only for the generation of business. In the event of the Prospect/
:& /#$%"#$%&4()0 )/#%.(&,"#%-#)-,&#,&,4(.$1(-&!7&"'(&6 /4#%7: Policyholder rejecting the policy for the reason that the product was not what he had required,
p. undergo Anti Money Laundering (“AML”) training and adhere to AML/ Know Your Customer such sale shall be treated as a mis-sale and the Company reserves the rights to penalize you
guidelines. !7&5#7& 0&1%(&#%-? )&4(%#2&#."$ %&#,&"'(&6 /4#%7&/#7&-((/&1":&@ +&/+,"&0+227&+%-(),"#%-&"'(
q. provide all collected customer information to the Company and extend cooperation for any requirements of the Prospect/ Policyholder and then suggest a suitable product;
investigation or information of your sourced customers. p. be entitled to commission on any policy taken out by you on your own life unless you have
r. pay special attention to business relationships and transactions, especially those which do secured policies on six different lives excluding your own and you have also been an insurance
not have apparent economic or visible lawful purpose. In all such cases, the background #3(%"&. %"$%+ +,27&0) /&"'(&"$/(& 0&7 +)&, 2$.$"$%3& )&4) .+)$%3&"'(&1),"&4 2$.7& %&(#.'& 0&,+.'
and purpose of such transactions as far as possible, have to be examined and written six lives or proposing on the policy of your own life, whichever is earlier, till the time when the
1%-$%3,&,'#22&!(&/#$%"#$%(-&0 )&#,,$,"$%3&"'(&6 /4#%7: policies on those six lives and the policy on your own life have all been issued as per the terms
s. promptly deliver to the Company in good order and condition, when demanded all records, and conditions of Insurance Act, 1938 and rules framed thereof;
rate books, documents, manuals, stationary forms and all other books and papers relating q. accept any risk for or on behalf of the Company;
in any way to the life insurance business of the Company and shall provide the list of all r. unless authorized by the Company in writing, issue any type of receipt/s whether on personal
Policy Holders along with policy details, contact details and other details available with you letterhead or on the Company’s behalf to any person, in respect of monies collected by you.
in writing as and when demanded by the Company. s. give anything in writing to the Policyholder or to any Prospect, whether on personal letterhead
t. promptly notify the Company of receipt by you or service of any complaint, notice or claim or on the letter head of the Company with regard to the product of the Company.
concerning or in relation to any matter governed by this appointment and shall promptly ":& 4) .+)(&J) +4&A%,+)#%.(&!+,$%(,,&0 )&"'(&6 /4#%7&+%2(,,&,4(.$1.#227&4()/$""(-&$%&5)$"$%3&!7&
deliver a copy to the Company. the Company.
u. be eligible to make any calls (subject to TRAI/ IRDA regulations) for procuring or servicing u. act as an insurance agent for more than one life insurance Company as in accordance with
insurance business for the Company. the Guidelines on Appointment of Insurance Agents, 2015 issued by Insurance Regulatory and
v. receive communication from HDFC Life in connection with the agency and in this regard Development Authority of India. You may however act as a general insurance agent for one
#3)((& #%-& +%-(),"#%-& "'#"& ,+.'& . //+%$.#"$ %& 5$22& % "& !(& .2#,,$1(-& #,& ;6 //().$#2& general insurer and /or agent for one stand alone Health Insurer and/ or one of each of the
Communication/ Unsolicited Communication” under the TRAI regulations mono-line insurers subject to your meeting the applicable regulatory requirements
w. be contacted for all updates and latest Company information even if registered under >:& !(&(2$3$!2(&0 )&#%7&$%.$-(%"#2&!(%(1",&<(:3:&K(5#)-,B&)(5#)-&4 $%",=B&-()$>$%3& +"& 0&7 +&!($%3& +)
‘DND’. Financial Consultant, on your separation (resignation/termination) with the Company. All such
x. make Prospects’/ Policyholder’s premium payment by way of crossed-cheques, demand +%+,(-&$%.$-(%"#2&!(%(1",B&"' +3'&#..)+(-B&5$22&#+" /#"$.#227&2#4,(& %&7 +)&,(4#)#"$ %:
-)#0",& #%-& .#,'& <#,& 4()& 2$/$",& ,4(.$1(-& !7& "'(& 6 /4#%7=& 5'$.'& $,& #.. /4#%$(-& 5$"'& w. advertise and do any kind of publicity without written authority from the Company either by
Prospects’/ Policyholder’s Pan Card details. You shall inform and encourage the Prospect/ yourself or through an authorized person, and you shall, during the conduct of business
Policyholder to write his/her policy number or other details on the back of the cheque/ with us, adhere to the provisions of the Insurance Regulatory and Development Authority
demand draft. In this regards you shall not use your own cash, your account or your credit/ (Insurance Advertisements and Disclosure) Regulations, 2000 as amended from time to time. In
debit cards in making payments on behalf of the Policyholders. accordance with the advertisement regulations issued by the IRDA, you are required to obtain
7:& /#$%"#$%& ,")$."& . %1-(%"$#2$"7& 0& "'(& $%0 )/#"$ %& )(.($>(-& 0) /& #%7& 9) ,4(."?9 2$.7' 2-()& prior approval in writing, of the Company for issue of any advertisement prior to the issue.
and/or the Company in the course of business (hereinafter referred to as / !"#$%"&'()* However such prior written approval is not required for:
0"1!-2(&'!".) and ensure the following: i. Advertisements developed by the Company and provided to you;
#:& @ +& #3)((& "'#"& "'(& 6 %1-(%"$#2& A%0 )/#"$ %& $,& " & !(& . %,$-()(-& . %1-(%"$#2& #%-& ii. Generic advertisements limited to information like the your name , logo , address, phone number
4) 4)$("#)7& " & "'(& 6 /4#%7& #%-& 7 +& ,'#22& ' 2-& "'(& ,#/(& $%& . %1-(%.(B& #%-& ,'#22& and,
% "& +,(& "'(& 6 %1-(%"$#2& A%0 )/#"$ %& "'()& "'#%& 0 )& "'(& 4+)4 ,(,& 0& !+,$%(,,& 5$"'& iii. Advertisements that consist only of simple and correct statements describing the availability of
"'(&6 /4#%7B&#%-&,'#22&-$,.2 ,(&$"& %27&" &$",& 01.(),B&-$)(." ),B& )&(/42 7((,& 0&"'(& 2$%(,& 0&$%,+)#%.(B&)(0()(%.(,&" &(D4()$(%.(B&,()>$.(&#%-&*+#2$1.#"$ %,& 0&#3(%",&!+"&/#C$%3&% &
6 /4#%7&5$"'&#&,4(.$1.&%((-&" &C% 5:&@ +&,'#22&% "&-$,.2 ,(B&4+!2$,'& )& "'()5$,(& )(0()(%.(&" &,4(.$1.&4 2$.$(,&B&!(%(1",B&. ,",& )&$%,+)(),:
)(>(#2& #%7& 0& "'(& 6 %1-(%"$#2& A%0 )/#"$ %& )(.($>(-& 0) /& "'(& 6 /4#%7& #%-? )& "'(&
x. act in contravention to the provision of Section 42(3) of Insurance Act, 1938 as amended from
9) ,4(."& " & #%7& "'()& "'$)-& 4#)"7& 5'#", (>()& (D.(4"& 5$"'& "'(& ,4(.$1.& 4)$ )& 5)$""(%&
"$/(&" &"$/(B&0#$2$%3&5'$.'&7 +&5$22&!(&-$,*+#2$1(-&" &#."&#,&#%&$%,+)#%.(&#3(%"& 5$%3&" &5'$.'B&
authorization of the Company.
your appointment shall be cancelled, and the Company may recover from you the appointment
!:& E'(& 6 %1-(%"$#2& A%0 )/#"$ %& 0+)%$,'(-& $%& "#%3$!2(& 0 )/& ,'#22& % "& !(& -+42$.#"(-& !7 letter and the identity card issued earlier along with all other documents, literatures, booklets,
you except in the course of business. Upon the request of the Company, you shall tables etc. that belong to the Company.
)("+)%&#22&"'(&6 %1-(%"$#2&A%0 )/#"$ %&)(.($>(-&$%&5)$""(%& )&"#%3$!2(&0 )/B&$%.2+-$%3
y. Unless authorized by the Company, collect any money/premium in cash from the Prospects and/
. 4$(,B& )& )(4) -+."$ %,& )& "'()& /(-$#& . %"#$%$%3& ,+.'& 6 %1-(%"$#2& A%0 )/#"$ %B&
or Policyholder under any circumstances and shall be under obligation to disclose the Prospect/
within ten (10) days of such request. Any documents or other media developed by
Policyholder that the payment towards premium charges shall be accepted by the Company
7 +&. %"#$%$%3&6 %1-(%"$#2&A%0 )/#"$ %&/#7&!(&-(,") 7(-&!7&7 +:&@ +&,'#22&4) >$-(&
except under the prescribed limits of the Company.
#& 5)$""(%& .()"$1.#"(& " & "'(& 6 /4#%7& )(3#)-$%3& -(,")+."$ %& 5$"'$%& "(%& <FG=& -#7,&
thereafter. z. violate any guidelines/ process related to AML, if found, appropriate action will be taken
accordingly.
.:& @ +&,'#22&'#>(&% & !2$3#"$ %&+%-()&"'$,&H44 $%"/(%"&I(""()B&5$"'&)(,4(."&" &6 %1-(%"$#2&
Information which is or becomes publicly available, except wherein the same is due to ##:& 2 -3(?12(& )&"')(#"(%&" &2 -3(?12(&#%7&,+$"& )&2(3#2&4) .((-$%3,&#3#$%,"&#%7&"'$)-&4(), %& )&#%7&
breach of the terms and conditions under this Appointment Letter; is rightfully received matter arising out of or in connection with the Company’s business.
!7& 7 +& 5$"' +"& !2$3#"$ %,& 0& . %1-(%"$#2$"7& )& $,& -(>(2 4(-& !7& 7 +B& ' 5(>()& ,+.' 03 PENALTY
receipt or development needs to be supported with written documentation. In case you act in contravention of the provisions of the Guidelines on Appointment of Insurance
z. procure certain minimum business from rural sector and/or social sector, on the advice of Agents, 2015, issued by IRDAI you shall be liable to a penalty which may extend to ten thousand
the Company. rupees and any person acting on behalf of an insurer, who appoints any person as an insurance
aa. in the event of soliciting business (in a distant mode) in a foreign country within the agent not permitted to act as such or transact any insurance business in India through any such
regulatory regime, you shall strictly abide by the laws of such country. Any liability or action person shall be liable to penalty which may extend to one crore rupees, as per the provisions of the
arising in this behalf shall be your sole responsibility & HDFC Life shall not be responsible Insurance Act, 1938, and the Insurance Regulatory and Development Authority Act, 1999.
for the same. 53* 67 89+9:0;<*;=*0<:7<:
ab. authorize the Head – Distribution Planning and Program Management of the Company to @ +B&'()(!7&. %1)/&"'#"& %&7 +)&#44 $%"/(%"&#,&#&L$%#%.$#2&6 %,+2"#%"& 0&MNL6&I$0(&7 +&5$22&0+227&
act as a group organizer/Manager to arrange the group insurance on the life of a Financial co-operate with the Company, to disclose all such facts, and provide all such details and attest the
Consultant as and when eligible for the same. It is understood that the eligibility for the ,#/(&!7&4) >$-$%3&,+.'&.()"$1(-&")+(&. 4$(,& 0&- .+/(%"#"$ %&#%-&$%&3(%()#2&0 22 5&,+.'&3+$-(2$%(,B&
Group Insurance shall be on the basis of criteria to be decided by the Head – Distribution as prescribed, in this regard, and as may be reasonably required by the Company, from time to time,
Planning and Program Management at his sole discretion from time to time. and maintain and do all such acts, things, deeds necessary in terms of the regulations and rules
003 YOU SHALL NOT4 framed by IRDAI and any other judicial / quasi-judicial authority and such other policies framed by
the Company, to ensure due compliance with the laws of India.
a. solicit or procure insurance business without being appointed to act as such by the Company;
@ +B& 0+)"'()& #+"' )$,(& "'(& 6 /4#%7& " & ,((CO. %1)/& "'(& ,#$-& $%0 )/#"$ %& -+(& 0) /& 7 +O4) >$-(-&
b. expose the Company to money laundering activity and will not accept any business, wherein
by you from any other reliable third-party source, at the sole discretion of the Company. Further,
Prospect/ Policyholder has requested for laundering of fund;
subject to your appointment you also agree and authorise the Company to withhold payment of, any
c. induce or persuade any Prospect to omit any material information in the proposal form; . //$,,$ %& )&!(%(1",B&-+(&" &7 +B&$%&.#,(&7 +&0#$2&" &-$,.'#)3(&7 +)& !2$3#"$ %B&#,&,"#"(-B&#0 )(,#$-B&
d. induce the Prospect to submit wrong information in the proposal form or documents submitted "$22&,+.'&"$/(&"'(&,#$-&)(*+$)(/(%"&)(/#$%,&+%0+2122(-:
to the Company for acceptance of the proposal;

___________________________________
Signature of Applicant
FC10
 7,,9&:;<=)*$#+,-

./012$3$#45!6.6452$4"$788465.1/5.
This is with reference to your application for appointment as a life insurance agent with HDFC Life Company that are in your possession, to the Company. Upon termination of agency you shall
Insurance Company Ltd., (hereinafter referred to as >=?($ #+@,;<-AB$ > !"#$ %&'(AB$ >C(A). Your cease to represent yourself as the Company’s agent or use the Company’s name or logo
!!"#$%&'$%( )#%*( +,-.( /#0'( )#11( 2'( 3"$45&'6( "$( #778 $3'( "0( $( !!"#$%&'$%( 1'%%'5( 9 !""#$%&'(%&) (directly or indirectly or by reference) in any manner whatsoever.
*(&&(+,) by HDFC Life, pursuant to your compliance with the Guidelines for Appointment of Insurance iii. In the event of the agency being terminated within a period of 24 months from the date of
Agents, 2015 issued by Insurance Regulatory and Development Authority of India (hereinafter referred to appointment, the Company shall be entitled to claim the entire costs incurred towards training
as -./!-,). The Terms & Conditions mentioned herein is applicable to you subject to your appointment you. The Company reserves the right to determine the extent of costs incurred as aforesaid.
as Financial Consultant of HDFC Life. On issuance of Appointment Letter by HDFC Life the below
+@># J)3#)&*+4"#*&#$"#."-@",#!"-"7),"-#.!1%%#$"#.7=84+")*%3#."-@",#&)#*!"#0&(21)3C#+=#."-@",#$3
mentioned Terms & Conditions are deemed to be accepted by you.
;"<+.*"-",#K&.*#1*#+*.#;"<+.*"-",#L=84"C#1),#.!1%%#$"#.7=84+")*%3#."-@",#&)#3&7#+=#.")*#*&#3&7
!"#$"%&'#(")*+&)",# "-(.#/#0&),+*+&).#.!1%%#122%3#*&#1%%#*-1).14*+&)5.6#$"*'"")#7.#1.#(13#$"#.2"4+8",# by Registered Post/courier/email at the address mentioned hereinabove or at your last known
from time to time by the Company in addition to the relevant laws of India, in general, and in particular to address.
the provisions of the Insurance Act, 1938, and the Insurance Regulatory and Development Authority Act,
v. Any dispute arising within the terms of this Appointment Letter shall be subject to the jurisdiction
9:::#1),#*!"#;7%".#1),#;"<7%1*+&).#.2"4+8",#*!"-"#7),"-#1.#1("),",#=-&(#*+("#*&#*+(">
of the Courts at Mumbai.
!0) APPOINTMENT OF FINANCIAL CONSULTANT [FC]1
70) COMMISSIONS AND PAYMENTS
Your appointment as the Company’s Financial Consultant to source business from anywhere in India
i. !"#$%&'()*#+,--#'(*#.%&&,//,%)#0%#*%1#0!2%13!#"4'(*&")0#&%5"#%)-*#,6"6#7$89:7; 6
is at all times subject to your adhering to and in accordance with the terms and conditions of your $%&&,//,%)/#/!(--#<"#'(,5#=%2#'%-,.,"/#/%12."5#<*#*%1>#+!,.!#!(?"#<"")#,)#=%2."#=%2#(#'"2,%5#%=#
appointment and complying with the relevant guidelines/ regulations. Further your appointment is 0+")0*4=,?"9=%20*#5(*/#=2%&#0!"#5(0"#%=#,//1()."6# !"#'(*&")0#.*.-"#+,--#<"#5".,5"5#<*#0!"#$%&'()*#
$1.",#&)#*!"#-"2-".")*1*+&)#*!1*#3&7#,&#)&*#.7=="-#=-&(#1)3#,+.?71%+841*+&).#1.#(")*+&)",#7),"-# ()5#,)=%2&"5#0%#*%1#=2%&#0,&"#0%#0,&"6#$%&&,//,%)#&(*#<"#'10#%)#!%-5#,)#.(/"#%=#,)?"/0,3(0,%)#<*#0!"#
Section 42(3) of the Insurance Act, 1938 read with relevant IRDAI rules, regulations, guidelines & $%&'()*#=%2#=2(15>#@1(-,0*#%=#<1/,)"//#"0.6
circulars, as issued/ amended from time to time. ii. $%&&,//,%)#/!(--#<"#'(,5#,)#A)5,()#B1'""/#%)-*6
20) DIRECTORSHIPS)3)4567.)-89:.!8;7)!;5-<-5=1
iii. !"#$%&'()*#/!(--#'(*#.%&&,//,%)#(/#'"2#,0/#,)0"2)(-#'%-,.*>#%)#0!"#'2"&,1&#3")"2(0"5#<*#*%1#()5#
As required under the Guidelines on Appointment of Insurance Agents, 2015, the Financial 0!"#2(0"/#()5#&%5"/#%=#'(*&")0#%=#.%&&,//,%)>#+,--#<"#,)=%2&"5#0%#*%1#<*#0!"#$%&'()*#=2%&#0,&"#0%#
Consultant of the Company is not entitled to become or remain a director of any Insurance Company. 0,&"6
Further the Financial Consultant is not entitled to hold any other relationship with any life insurance
iv. A)#.(/"#%=#0"2&,)(0,%)#%=#(3").*>#.%&&,//,%)#'(*(<-"#C,=#()*D#+,--#<"#&(5"#,)#(..%25()."#+,0!#0!"##
0&(21)3#+)#-".2"4*#&=#1)3#+).7-1)4"#14*+@+*+".#.74!#1.#A-&B"-C#0&-2&-1*"#1<")*C#D2"4+8",#2"-.&)C# $%&'()*E/##'%-,.*>#+!,.!#+,--#<"#1'5(0"5#%)#$%&'()*E/#'%20(-#=2%&#0,&"#0%#0,&"
Referral etc.
v. $%&&,//,%)#/!(--#<"#/1<F".0#0%#5"51.0,%)/#%=#0(G#1)5"2#0!"#'2%?,/,%)#%=#A).%&"# (G#H.0>#IJKI#()5#()*#
;0) INDEMNITY %0!"2#(''-,.(<-"#-(+>#(/#(&")5"5#=2%&#0,&"#0%#0,&"6
i. The relationship between HDFC Life and the Financial Consultant shall be solely that of
vi. L10#%=#0!"#0%0(-#M%%5/#N#8"2?,."/# (G#CM8 D#-,(<,-,0*#%)#0!"#.%&&,//,%)/>#(#'%20,%)#%=#M8 >#(/#
principal and agent in relation to the insurance business/ policies. You agree and acknowledge &101(--*#(32""5#=2%&#0,&"#0%#0,&">#+,--#<"#<%2)"#<*#0!"#$%&'()*#()5#0!"#<(-()."#'%20,%)#%=#M8 #+,--#
*!1*# *!"# $")"8*# &=# *!"# -"%1*+&).!+2# '+*!# 1)3# "E+.*+)<# 47.*&("-F# 2&%+43!&%,"-# > ?#@$ABC#@D(+,) <"#<%2)"#<*#*%1#()5#+,--#<"#(5F1/0"5#(3(,)/0#0!"#.%&&,//,%)#'(*%10/6# !"#2(0,%#(/#&101(--*#(32""5#
introduced by you belongs to HDFC Life and you shall not do anything following termination of =2%&#0,&"#0%#0,&"#=%2#/!(2,)3#%=#M8 #(/#&")0,%)"5#(<%?"#/!(--#<"#5,/'-(*"5#%)#0!"#$%&'()*E/#'%20(-#
this Agreement, or otherwise, to prejudice the continuing relationship between HDFC Life and $%)/1-0()0#$%2)"2#(/#(#2"(5*#2"="2")."#()5#0!"#5"0(,-/#%=#0!"#/(,5#5"51.0,%)#/!(--#(-/%#<"#
.%&&1),.(0"5#0%#*%1#0!2%13!#*%12#.%&&,//,%)#/0(0"&")06#
the Policyholder .
ii. You shall perform activities only to the extent and subject to the terms and conditions as vii. $%&&,//,%)#%)#2"51."5#'2"&,1&/#()5#'2"&,1&/#)%0#.%--".0"5#51"#0%O
,4$!"@1"#<%1)."
authorized by HDFC Life in writing. You shall be solely & personally liable for all acts which ,,4$()."--(0,%)##%=#2,5"2/##N#P%-,.,"/#,).-15,)3##0!%/"##5%)"##512,)3##0!"#;2""#-%%Q4,)4P"2,%5>
are not approved or authorized by the Company in writing or due to your default, negligence or ,,,4:%)#R,/.-%/12"#.()."--(0,%)/#
unlawful act or omission. You agree to indemnify and hold the Company and its representatives, /!(--#<"#5"51.0"5#=2%&#0!"#.%&&,//,%)#'(*(<-"#0%#*%16#
&=84"-.C#1<")*.#1),#1..+<).#5G;"2-".")*1*+@".H6#!1-(%"..#1*#1%%#*+(".#=-&(#1),#1<1+).*#1)3#1),
viii. P%-,.*#.()."--(0,%)/#%2#<1/,)"//#2"?"2/(-/#,),0,(0"5#51"#0%#.1/0%&"2#.%&'-(,)0/#+,--#-"(5#2".-(,&9
all liability, damages, losses, claims, cost and expenses (including any fees and expenses) and 2".%?"2*#%=#.%&&,//,%)/#()5#<")"=,0/#'(,5#%10#0%#*%16# !,/#.-(1/"#/!(--#/12?,?"#0!"#0"2&,)(0,%)#%=#0!,/#
any other loss that may occur or arise due to your acts or omissions which are not approved or H''%,)0&")0#S"00"26
authorized by HDFC Life in writing or due to your default, negligence or unlawful act or omission.
ix. !"#$%&'()*#&(*#.!(23"#()#(&%1)0#=%2#.%&'-"0,)3#0!"#(''%,)0&")0#'2%."//#C,).-15,)3#02(,),)3D#(0#
iii. You agree to indemnify and hold the Company and its Representatives harmless from and 0!"#0,&"#%=#(''-*,)3#=%2#-,="#,)/12()."#(3").*6
against any and all liability, damages, losses, claims, cost and expenses (including any fees
and expenses) and any other loss that may occur or arise from or relate to breach of any of the E0) F-8-F:F)2:9-8799)95!8/!./9)G).7H:-.7F7859)48)?7.9-9578;=
obligations undertaken by you or your representatives, including but not limited to instances
i. You shall maintain Persistency Rate and Minimum Business Standards as communicated by the
wherein such loss/ damage is caused due to any negligent act, omission, willful misconduct or
Company from time to time.
misrepresentation.
ii. You shall maintain a correct and complete record of the various policies sold and their
iv. You agree to indemnify, defend and hold harmless HDFC Life and its Representatives against
persistency on a year on year basis.
any liability or loss that may occur due to complaints registered by you and against you with
TRAI for receiving/ making calls from or on behalf of HDFC Life. iii. Non adherence to Persistency Rate and Minimum Business Standards will lead to withholding/
-"4&@"-3# &=# 4&((+..+&).# 1),# $")"8*.# 21+,# *&# 3&7># M*# (13# 1%.&# %"1,# *&# *"-(+)1*+&)# &=# 3&7-
/0) TERMINATION/ SUSPENSION OF THE AGEN;=1
agency.
i. Your appointment as a Financial Consultant of the Company shall be valid until terminated by
I0) 2:9-8799)?.!;5-;7)
either party as per terms and conditions of this Appointment Letter. Notwithstanding anything
contained in this Appointment Letter the Company is entitled to terminate the agency and your The Company is committed to high standards of legality and business ethics. It is a condition of this
appointment in accordance with the guidelines issued by IRDAI from time to time, without any appointment as well as of the continued relationship that you will in sourcing of policies observe
liability for compensation or damages in the below mentioned circumstances: high levels of legality and business ethics. Notwithstanding the termination clause if you breach the
business ethics, this Appointment Letter will stand terminated, in accordance with the guidelines
(a) Your performance has not been satisfactory as per Company’s policy; or
issued by IRDAI from time to time. You will strictly comply with all laws, rules, regulations and
(b) Violation or non compliance with statutory/ regulatory norms; or guidelines of IRDAI.
(c) You have acted in breach of the code of conduct; or All communications with/ to you will be in electronic form (email / sms/ company portal) at the email/
(d) Violation of the terms and conditions of your appointment; or mobile registered with the Company/ informed to you.
(e) Any information furnished by you in relation with the appointment is false, misleading, 60) CODE OF CONDUCT
incorrect or untrue; or -)0) =4:)96!**J
(f) Acted in a fraudulent manner; or a. identify yourself as an insurance agent of the Company, to all the prospective policyholders/
5<6# I&7#!1@"#1#;"%1*+@"#'&-B+)<#1.#1)#"(2%&3""#'+*!#*!"#0&(21)3># !"#,"8)+*+&)#&=#;"%1*+@"# customers (hereinafter referred to as ?+#K"(A&>KL,);
is “spouse, dependent children or dependent step children, whether residing with you or b. show the identity card issued by the Company to the Prospect, and also disclose the
not”; or agency appointment letter to the Prospect on demand;
(h) Failure to furnish any information/ books of accounts relating to your activities as an agent c. disseminate the correct and requisite information in respect of insurance products
as required by the Company or IRDAI; or offered for sale by the Company and take into account the needs of the Prospect while
(i) Failure to comply with the directions issued by IRDAI; or recommending the products;
(j) Provided wrong or false information; or concealed or failed to disclose material facts in the d. disclose the scales of commission in respect of the insurance product offered for sale, if
application submitted for appointment; or asked by the Prospect;
(k) Failure to submit periodical returns as required by the Insurer/IRDAI; or e. indicate the premium to be charged by the Company for the insurance product offered for
(l) Non co-operation with any inspection or enquiry conducted by IRDAI; or sale;
(m) Failure to resolve the complaints of the Policyholders or fails to give a satisfactory reply to f. explain to the Prospect the nature of information required in the proposal form by the
IRDAI in this behalf; or Company, and also the importance of disclosure of material information in the purchase
of an insurance product and shall discourage suppression of any information which is
(n) Performance of any act (individually or as a part of group) which is against the Company or
relevant to the Company for the purpose of underwriting;
is for defaming the Company or any of its employees/ business associates; or
g. bring to the notice of the Company any adverse habits or income inconsistencies of
(o) Your behavior in a discourteous manner with any Prospect/ Policyholder or with the
the Prospect, in the form of a report (hereinafter referred to as E$%M%A$M@) ;#%KN@&M%&)
Company / any of its Representatives.
ii. Upon termination of agency you shall forthwith surrender the appointment letter and identity
card as well as all other manuals, tables, rate books, literatures, product guides etc. of the

___________________________________
Signature of Applicant
FC11
 ;#%OD(%&$M@) .("#+&,) along with every proposal submitted to the Company, and any e. resort to multilevel marketing for soliciting and procuring insurance policies and/or induct any
material fact that may adversely affect the underwriting decision of the Company as regards Prospect/Policyholder to join a multilevel level marketing scheme;
acceptance of the proposal, by making all reasonable enquiries about the Prospect; f. inform Customer about any investigation or reporting done under AML, if known to you.
h. &$*1+)#*!"#-"?7+.+*"#,&47(")*.#1*#*!"#*+("#&=#8%+)<#*!"#2-&2&.1%#=&-(#'+*!#*!"#0&(21)3N g. behave in a discourteous manner with the Prospect/ Policyholder or with the Company / any of
and other documents subsequently asked for by the Company for completion of the its Representatives;
proposal;
h. interfere with any products/proposals/business transactions introduced by any other insurance
i. inform promptly to the Prospect about the acceptance or rejection of the proposal by the agent;
Company;
i. offer different rates, advantages, terms and conditions other than those offered by the Company;
j. advise every Prospect to effect nomination or assignment or change of address or exercise
j. provide any misleading/ wrong information to the Policyholder related to AML;
of options, as the case may be, and offer necessary assistance in this behalf, wherever
necessary; B># ,"(1),#&-#-"4"+@"#1#.!1-"#&=#4%1+(#2-&4"",.#=-&(#*!"#$")"84+1-3#7),"-#1)#+).7-1)4"#4&)*-14*#
or offer any share payable out of the commission which may be received by you from the
k. -"),"-#)"4"..1-3#1..+.*1)4"#*&#*!"#K&%+43!&%,"-#&-#4%1+(1)*.#&-#$")"84+1-+".#+)#4&(2%3+)<
Company.;
with the requirements for settlement of claims by the Company;
l. force, persuade or induce a Prospect/Policyholder to terminate any existing policy and to effect
l. make every attempt to ensure remittance of the premiums by the Prospect/ Policyholder
a new proposal from him within three years from the date of such termination of the earlier
within the stipulated time, by giving notice to the Prospect/ Policyholder orally and in writing
policy;
with a view to conserve the insurance business already procured by you.
m. apply for fresh agency appointment to act as an insurance agent, if your agency appointment
m. If collects a premium on a policy of insurance on behalf of an insurer, you will deposit with,
'1.#"1-%+"-#41)4"%%",#$3#*!"#,".+<)1*",#&=84+1%C#1),#1#2"-+&,#&=#8@"#3"1-.#!1.#)&*#"%12.",#=-&(
or dispatch by post to, the insurer, the premium so collected in full without deduction of your
the date of such cancellation;
commission within twenty-four hours of the collections excluding bank and postal holidays.
n. become or remain a director of any insurance Company;
n. observe and adhere and also bring the same to the notice of the Prospect/ Policyholder the
provisions of Section 41 of the Insurance Act, 1938. o. induce any Prospect/ Policyholder into accepting any product, which the Prospect/ Policyholder
did not initially need, only for the generation of business. In the event of the Prospect/
&># (1+)*1+)#2"-=&-(1)4"#.*1),1-,.#1.#.2"4+8",#$3#*!"#0&(21)3>
Policyholder rejecting the policy for the reason that the product was not what he had required,
p. undergo Anti Money Laundering (“AML”) training and adhere to AML/ Know Your Customer such sale shall be treated as a mis-sale and the Company reserves the rights to penalize you
guidelines. $3#'13#&=#8)"#1),F&-#2")1%#14*+&)#1.#*!"#0&(21)3#(13#,""(#8*>#I&7#(7.*#=7%%3#7),"-.*1),#*!"
q. provide all collected customer information to the Company and extend cooperation for any requirements of the Prospect/ Policyholder and then suggest a suitable product;
investigation or information of your sourced customers. p. be entitled to commission on any policy taken out by you on your own life unless you have
r. pay special attention to business relationships and transactions, especially those which do secured policies on six different lives excluding your own and you have also been an insurance
not have apparent economic or visible lawful purpose. In all such cases, the background 1<")*#4&)*+)7&7.%3#=-&(#*!"#*+("#&=#3&7-#.&%+4+*+)<#&-#2-&47-+)<#*!"#8-.*#2&%+43#&)#"14!#&=#.74!
and purpose of such transactions as far as possible, have to be examined and written six lives or proposing on the policy of your own life, whichever is earlier, till the time when the
8),+)<.#.!1%%#$"#(1+)*1+)",#=&-#1..+.*+)<#*!"#0&(21)3> policies on those six lives and the policy on your own life have all been issued as per the terms
s. promptly deliver to the Company in good order and condition, when demanded all records, and conditions of Insurance Act, 1938 and rules framed thereof;
rate books, documents, manuals, stationary forms and all other books and papers relating q. accept any risk for or on behalf of the Company;
in any way to the life insurance business of the Company and shall provide the list of all r. unless authorized by the Company in writing, issue any type of receipt/s whether on personal
Policy Holders along with policy details, contact details and other details available with you letterhead or on the Company’s behalf to any person, in respect of monies collected by you.
in writing as and when demanded by the Company.
s. give anything in writing to the Policyholder or to any Prospect, whether on personal letterhead
t. promptly notify the Company of receipt by you or service of any complaint, notice or claim or on the letter head of the Company with regard to the product of the Company.
concerning or in relation to any matter governed by this appointment and shall promptly
*># 2-&47-"#Q-&72#M).7-1)4"#$7.+)"..#=&-#*!"#0&(21)3#7)%"..#.2"4+841%%3#2"-(+**",#+)#'-+*+)<#$3#
deliver a copy to the Company.
the Company.
u. be eligible to make any calls (subject to TRAI/ IRDA regulations) for procuring or servicing
u. act as an insurance agent for more than one life insurance Company as in accordance with
insurance business for the Company.
the Guidelines on Appointment of Insurance Agents, 2015 issued by Insurance Regulatory and
v. receive communication from HDFC Life in connection with the agency and in this regard Development Authority of India. You may however act as a general insurance agent for one
1<-""# 1),# 7),"-.*1),# *!1*# .74!# 4&((7)+41*+&)# '+%%# )&*# $"# 4%1..+8",# 1.# G0&(("-4+1%# general insurer and /or agent for one stand alone Health Insurer and/ or one of each of the
Communication/ Unsolicited Communication” under the TRAI regulations mono-line insurers subject to your meeting the applicable regulatory requirements
w. be contacted for all updates and latest Company information even if registered under @># $"#"%+<+$%"#=&-#1)3#+)4+,")*1%#$")"8*.#5"><>#;"'1-,.C#-"'1-,#2&+)*.6C#,"-+@+)<#&7*#&=#3&7#$"+)<#&7-
‘DND’. Financial Consultant, on your separation (resignation/termination) with the Company. All such
x. make Prospects’/ Policyholder’s premium payment by way of crossed-cheques, demand 7)7.",#+)4+,")*1%#$")"8*.C#*!&7<!#144-7",C#'+%%#17*&(1*+41%%3#%12."#&)#3&7-#."21-1*+&)>
,-1=*.# 1),# 41.!# 51.# 2"-# %+(+*.# .2"4+8",# $3# *!"# 0&(21)36# '!+4!# +.# 144&(21)+",# '+*!# w. advertise and do any kind of publicity without written authority from the Company either by
Prospects’/ Policyholder’s Pan Card details. You shall inform and encourage the Prospect/ yourself or through an authorized person, and you shall, during the conduct of business
Policyholder to write his/her policy number or other details on the back of the cheque/ with us, adhere to the provisions of the Insurance Regulatory and Development Authority
demand draft. In this regards you shall not use your own cash, your account or your credit/ (Insurance Advertisements and Disclosure) Regulations, 2000 as amended from time to time. In
debit cards in making payments on behalf of the Policyholders. accordance with the advertisement regulations issued by the IRDA, you are required to obtain
3># (1+)*1+)# .*-+4*# 4&)8,")*+1%+*3# &=# *!"# +)=&-(1*+&)# -"4"+@",# =-&(# 1)3# K-&.2"4*FK&%+43!&%,"-# prior approval in writing, of the Company for issue of any advertisement prior to the issue.
and/or the Company in the course of business (hereinafter referred to as ;#%OD(%&$M@) However such prior written approval is not required for:
-%P#+'M&$#%,) and ensure the following: i. Advertisements developed by the Company and provided to you;
1># I&7# 1<-""# *!1*# *!"# 0&)8,")*+1%# M)=&-(1*+&)# +.# *&# $"# 4&).+,"-",# 4&)8,")*+1%# 1),# ii. Generic advertisements limited to information like the your name , logo , address, phone number
2-&2-+"*1-3# *&# *!"# 0&(21)3# 1),# 3&7# .!1%%# !&%,# *!"# .1("# +)# 4&)8,")4"C# 1),# .!1%%# and,
)&*# 7."# *!"# 0&)8,")*+1%# M)=&-(1*+&)# &*!"-# *!1)# =&-# *!"# 27-2&.".# &=# $7.+)"..# '+*!#
iii. Advertisements that consist only of simple and correct statements describing the availability of
*!"#0&(21)3C#1),#.!1%%#,+.4%&."#+*#&)%3#*&#+*.#&=84"-.C#,+-"4*&-.C#&-#"(2%&3"".#&=#*!"#
%+)".#&=#+).7-1)4"C#-"="-")4".#*&#"E2"-+")4"C#."-@+4"#1),#?71%+841*+&).#&=#1<")*.#$7*#(1B+)<#)&#
0&(21)3#'+*!#1#.2"4+84#)"",#*&#B)&'>#I&7#.!1%%#)&*#,+.4%&."C#27$%+.!#&-#&*!"-'+."#
-"="-")4"#*&#.2"4+84#2&%+4+".#C#$")"8*.C#4&.*.#&-#+).7-"-.>
-"@"1%# 1)3# &=# *!"# 0&)8,")*+1%# M)=&-(1*+&)# -"4"+@",# =-&(# *!"# 0&(21)3# 1),F&-# *!"#
K-&.2"4*# *&# 1)3# &*!"-# *!+-,# 21-*3# '!1*.&"@"-# "E4"2*# '+*!# *!"# .2"4+84# 2-+&-# '-+**")# x. act in contravention to the provision of Section 42(3) of Insurance Act, 1938 as amended from
authorization of the Company. *+("#*&#*+("C#=1+%+)<#'!+4!#3&7#'+%%#$"#,+.?71%+8",#*&#14*#1.#1)#+).7-1)4"#1<")*#&'+)<#*&#'!+4!C#
your appointment shall be cancelled, and the Company may recover from you the appointment
$># !"# 0&)8,")*+1%# M)=&-(1*+&)# =7-)+.!",# +)# *1)<+$%"# =&-(# .!1%%# )&*# $"# ,72%+41*",# $3
letter and the identity card issued earlier along with all other documents, literatures, booklets,
you except in the course of business. Upon the request of the Company, you shall
tables etc. that belong to the Company.
-"*7-)#1%%#*!"#0&)8,")*+1%#M)=&-(1*+&)#-"4"+@",#+)#'-+**")#&-#*1)<+$%"#=&-(C#+)4%7,+)<#
4&2+".C# &-# -"2-&,74*+&).# &-# &*!"-# (",+1# 4&)*1+)+)<# .74!# 0&)8,")*+1%# M)=&-(1*+&)C# y. Unless authorized by the Company, collect any money/premium in cash from the Prospects and/
within ten (10) days of such request. Any documents or other media developed by or Policyholder under any circumstances and shall be under obligation to disclose the Prospect/
3&7#4&)*1+)+)<#0&)8,")*+1%#M)=&-(1*+&)#(13#$"#,".*-&3",#$3#3&7>#I&7#.!1%%#2-&@+,"# Policyholder that the payment towards premium charges shall be accepted by the Company
1# '-+**")# 4"-*+841*"# *&# *!"# 0&(21)3# -"<1-,+)<# ,".*-74*+&)# '+*!+)# *")# 59O6# ,13.# except under the prescribed limits of the Company.
thereafter. z. violate any guidelines/ process related to AML, if found, appropriate action will be taken
4># I&7#.!1%%#!1@"#)&#&$%+<1*+&)#7),"-#*!+.#J22&+)*(")*#P"**"-C#'+*!#-".2"4*#*&#0&)8,")*+1%# accordingly.
Information which is or becomes publicly available, except wherein the same is due to 11># %&,<"F8%"#&-#*!-"1*")#*&#%&,<"F8%"#1)3#.7+*#&-#%"<1%#2-&4"",+)<.#1<1+).*#1)3#*!+-,#2"-.&)#&-#1)3#
breach of the terms and conditions under this Appointment Letter; is rightfully received matter arising out of or in connection with the Company’s business.
$3# 3&7# '+*!&7*# &$%+<1*+&).# &=# 4&)8,")*+1%+*3# &-# +.# ,"@"%&2",# $3# 3&7C# !&'"@"-# .74!# -0 PENALTY
receipt or development needs to be supported with written documentation. In case you act in contravention of the provisions of the Guidelines on Appointment of Insurance
z. procure certain minimum business from rural sector and/or social sector, on the advice of Agents, 2015, issued by IRDAI you shall be liable to a penalty which may extend to ten thousand
the Company. rupees and any person acting on behalf of an insurer, who appoints any person as an insurance
aa. in the event of soliciting business (in a distant mode) in a foreign country within the agent not permitted to act as such or transact any insurance business in India through any such
regulatory regime, you shall strictly abide by the laws of such country. Any liability or action person shall be liable to penalty which may extend to one crore rupees, as per the provisions of the
arising in this behalf shall be your sole responsibility & HDFC Life shall not be responsible Insurance Act, 1938, and the Insurance Regulatory and Development Authority Act, 1999.
for the same. Q0) /7;*!.!5-48)4E)-85785
ab. authorize the Head – Distribution Planning and Program Management of the Company to I&7C#!"-"$3#4&)8-(#*!1*#&)#3&7-#122&+)*(")*#1.#1#R+)1)4+1%#0&).7%*1)*#&=#STR0#P+="#3&7#'+%%#=7%%3#
act as a group organizer/Manager to arrange the group insurance on the life of a Financial co-operate with the Company, to disclose all such facts, and provide all such details and attest the
Consultant as and when eligible for the same. It is understood that the eligibility for the .1("#$3#2-&@+,+)<#.74!#4"-*+8",#*-7"#4&2+".#&=#,&47(")*1*+&)#1),#+)#<")"-1%#=&%%&'#.74!#<7+,"%+)".C#
Printed by : www.sapprints.com

Group Insurance shall be on the basis of criteria to be decided by the Head – Distribution as prescribed, in this regard, and as may be reasonably required by the Company, from time to time,
Planning and Program Management at his sole discretion from time to time. and maintain and do all such acts, things, deeds necessary in terms of the regulations and rules
--0 YOU SHALL NOTJ framed by IRDAI and any other judicial / quasi-judicial authority and such other policies framed by
a. solicit or procure insurance business without being appointed to act as such by the Company; the Company, to ensure due compliance with the laws of India.
b. expose the Company to money laundering activity and will not accept any business, wherein I&7C# =7-*!"-# 17*!&-+."# *!"# 0&(21)3# *&# .""BU4&)8-(# *!"# .1+,# +)=&-(1*+&)# ,7"# =-&(# 3&7U2-&@+,",#
Prospect/ Policyholder has requested for laundering of fund; by you from any other reliable third-party source, at the sole discretion of the Company. Further,
subject to your appointment you also agree and authorise the Company to withhold payment of, any
c. induce or persuade any Prospect to omit any material information in the proposal form;
4&((+..+&)#&-#$")"8*.C#,7"#*&#3&7C#+)#41."#3&7#=1+%#*&#,+.4!1-<"#3&7-#&$%+<1*+&)C#1.#.*1*",C#1=&-".1+,C#
d. induce the Prospect to submit wrong information in the proposal form or documents submitted *+%%#.74!#*+("#*!"#.1+,#-"?7+-"(")*#-"(1+).#7)=7%8%%",>
to the Company for acceptance of the proposal;

___________________________________
Signature of Applicant
FC12