Declaration

As per IRDA’s Guidelines for Individual Agents for Persistency of Life Insurance Policies, insurers need to
ensure that the relatives of employees are not engaged as agents of the Company.

“I hereby declare that:

A. I am aware that Relatives of employees of insurance companies cannot be engaged as agents by the
same insurer. None of my Relatives* is currently engaged with Tata AIA Life Insurance Company
Limited (TALIC) in the capacity of an Insurance Agent. If I become aware in the future, of any of my
Relatives being engaged as an agent with TALIC, I shall immediately forward the concerned Agent
Name and Agent Code to distopsinfo@tataaia.com.
OR
B. I am aware that Relatives of employees of insurance companies cannot be engaged as agents by the
same insurer. My Relative(s)* is / are engaged with Tata AIA Life Insurance Company Limited
(TALIC) in the capacity of Insurance Agent (Agent Name:
______________________________________; Agent Code: ___________________________). I
understand that the said agency may be terminated by TALIC. If I become aware in the future, of any
of my Relatives being engaged as an agent with TALIC, I shall immediately forward the concerned
Agent Name and Agent Code to distopsinfo@tataaia.com.

*‘Relative’ for this purpose means spouse, dependent children or dependent step children, whether residing
with the employee or not.

Please tick as appropriate.

Name: Designation: Signature: Date:

Declaration to Tata AIA Life Insurance Company Limited (Tata AIA Life)

I hereby state and confirm that all the information stated in the resume provided by me/ consultant is true.

I have never been interviewed or employed (off rolls/ on rolls) by Tata AIA Life and if any information is
subsequently found by Tata AIA Life to be false/ misleading, I will be liable to be immediately disqualified or
dismissed from service, without any notice or liability accruing to Tata AIA Life in this regard.

I hereby also declare that the following persons are my ‘Relatives’ who are currently employed with Tata AIA
Life:
(For this purpose, the term ‘Relatives’ is defined as_______________________)

Name Employee Designation Department Location Relationship

Code

(Please Note: Leaving the above table blank would be equivalent to a declaration that none of your
‘Relatives’ is currently employed with Tata AIA Life.)

Signature :
Name : Place: Date: