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APPLICATION FORM FOR STUDENT MEMBERSHIP

Note: Before completing this form the applicant should study the Instructions and Information given below. The completed form should be lodged with the Institute at the below mentioned address only. 302, Indian Globe Chambers, 142, Fort Street, Off D N Road, Near CST (VT) Station, Mumbai 400001 Tel: 67843333 Ext. 301, Fax: 678443330 E-mail: education@actuariesindia.org Admission fees for student membership is as under: Total Admission Fees inclusive of subscription up to March 2013 Rs. 1000/US $ 140/-

Status Resident in India/ and members of other SAARC Countries Resident in rest of the World

Note: a) Please send the fee by demand draft/pay order in favor of 'Institute of Actuaries of India payable at Mumbai. Demand Draft should not be stapled but attached with a U pin. b) During the Financial Year i.e. April to March, whenever the admission is taken, the subscription will be applicable only for that financial year e.g.:- For admission taken on 2nd March 2013 subscription will be valid till 31st March 2013. The subscription for 20132014 will be due on 1st April 2013. For further details kindly contact Ms. Vijaya Bhosale at actsoc@actuariesindia.org c) If you wish to appear for November 2012 exam diet, the Institute should receive this form duly filled by 25th July 2012. Membership forms received after this date will be eligible to appear for subsequent exam diets and NOT the May 2013 exam diet.

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This form must be completed in full. Failure to do so will result in your form being returned. Please use BLOCK CAPITAL and black ink when filling in this form.

Section 1 Application Details ACET Application Number:

e.g: IAIEE-JUN12-2000

Title:

Mr.

Mrs.

Miss

Dr.

Other

Please specify:

_________

Surname: First Name: Middle Name: Short Name: Father Name/ Husband Name: Mothers Name: Date of Birth: D D M M Y Y Y Y Nationality:

Failure to provide the correct correspondence address, telephone number and e-mail address, in clear handwriting, will result in the applicant not receiving information about their application form and forthcoming examination. So following information is Mandatory. RESIDENTIAL ADDRESS STD Code Tel. No. Mob No. Pin Code City State Country

Name Address

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PERMANENT ADDRESS STD Code Tel. No. Mob No. Pin Code

Name Address

City

State

Country

EMPLOYERS DETAILS, if employed. STD Code Tel. No. Fax No. Pin Code

Name Address

City

State

Country

Employer Code: ________________________ Employee Designation: __________________ E-mail ID : ___________________________________________________________________ (Alternate Email ID) ___________________________________________________________
Note: All the communication from IAI would be through email and hence it is essential that you mention your email id

Please indicate which address you would like all correspondence send to: Office: Residence: Permanent Address:

Are you a member of any other actuarial association? If so, please give the following information. Name of the Institute Membership No. Membership Class Details of subject passed

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Section 2 Criteria for becoming Student Member

A person is eligible for admission if he/she satisfies the following condition: 1) Resident in India (irrespective of nationality of the applicant) a) Passed ACET Exam (or) b) A student member from any of the following actuarial bodies provided at least one subject has been passed from these bodies (not on exemption basis) i) ii) iii) iv) Institute and Faculty of Actuaries, UK Institute of Actuaries of Australia Society of Actuaries, USA Casualty Actuarial Society, USA

2) Applicants of countries other than India should satisfy any one of the following criteria; i) ii) Passed 10+2(H.S.C) or equivalent with at least 85% in Mathematics/Statistics Graduate or Post Graduate with Mathematical subjects. For this purpose following subjects constitute mathematical subjects: a) Mathematics or any of its branches b) Statistics or any one of its sub classifications such as Mathematical Statistics and Applied Statistics c) Econometrics d) Computer Science e) Any discipline of Engineering f) Subject in Science Such as Physics or its branches The admission under these groups will, however be subject to the following conditions: i) The total marks secured in the subject coming under the clarification of mathematical subjects taken together in all the years of the Degree course not less than 55% ii) The content of Mathematical subjects content in all the years of the course taken together is not less than 50% of the total content iii) Fully qualified members of the following bodies in their respective countries a. Institute of Chartered Accountants b. Institute of Cost and Work Accountants

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iv)

A student member from the following actuarial bodies provided at least one subject has been passed from the bodies (not on exemption basis) a) b) c) d) Institute and Faculty of Actuaries, UK Institute of Actuaries of Australia Society of Actuaries, USA Casualty Actuarial Society, USA

Please note that medium of instruction in final state of examination based on which admission is sought should be English.

Section 3 Documents to be submitted

The documents which are required to be submitted along with Admission Application form; Sr. Category under which Attested Photocopies Required No application is made Resident in India (irrespective of nationality of the applicant) 1) ACET 1) Photocopy of your ACET application and result highlighting your name. 2) HSC (10+2) Marksheet and Passing Certificate Certificate of Passing of any 1 subject along with the proof of membership

2)

-Institute and Faculty of Actuaries UK, - Society of Actuaries, US - Institute of Actuaries of Australia - Casualty Actuarial Society, US

Resident outside India 1) 2) 3) 4) HSC(10+2) Graduation Post Graduation Fully Qualified Members of Institute of Chartered Accountants and Institute of Cost and Work Accountants Marksheet and Passing Certificate Marksheet and Passing Certificate of all years/semesters Marksheet and Passing Certificate of all years/semesters. Proof of Membership, Marksheet and Passing Certificate.

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5)

-Institute and Faculty of Actuaries UK, - Society of Actuaries, US - Institute of Actuaries of Australia - Casualty Actuarial Society, US

Certificate of Passing of any 1 subject along with the proof of membership

Compulsory Documents for all categories of membership 1) 2) 3) 4) Proof of Age Proof of English as one of the subject Passport Size Recent Photographs Change in Name Birth Certificate / School Leaving Certificate containing date of birth Relevant Marksheet and certificate Two If there is change in name then documentary evidence such as marriage certificate, Affidavit is required for the same. Marksheet and Passing Certificate Marksheet and Passing Certificate of all years/semesters. Marksheet and Passing Certificate of all years/semesters. Proof of Membership and Marksheet and Passing Certificate.

Optional Documents for all categories of membership 1) 2) 3) 4) HSC(10+2) Graduation Post Graduation Professional Qualification

Note.

Attestation should be done by class one officer in government/semi government organization or professionals, like C.A., ICWA, Gazzetted Officer, Notary, Actuary, Bank Manager, National Insurance Academy (NIA) Director etc. Professionals should mention their Institutes Membership number and affix their stamp. Attestation done by relatives is not valid.

Section: 4 Method of Payment

DD / Pay Order No. : ___________________ Drawn on : ___________________________ Dated : _____________

Amount : _________________

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Section 5: - Declaration to be Signed by Applicant

I apply for admission as a Student Member of Institute of Actuaries of India. If my application is approved I agree to confirm to the Rules and Professional Conduct Standards of the Institute as they currently exist or as they may in future be altered, amended or enlarged, and I will promote the objectives of the Institute to the best of my ability. I understand that to withdraw from membership I must inform the Institute of my resignation and that after payment of any arrears, return of books, papers or other property of the Institute, I will be free from these obligations. I further declare that I have not applied earlier to the Institute for admission as a member. Note : In case the applicant has earlier applied for admission as a member, the details of same should be furnished including whether such admission was granted or denied. Name (BLOCK LETTERS) Signature . Date . Place

Before signing this declaration you are advised to read the Rules & Regulations of the Institute, which is available on our Website, www.actuariesindia.org. Hard copies are available at IAI Office.

Section: 6 - Checklist
Please complete and assign the following. I have enclosed: certified copies of all educational / professional certificate (with English as one of the subjects) Proof of Date of Birth Change of Name, If any a) b) Enclosed the DD / Pay Order towards payment of Admission fees. Signed and dated the applicants declaration. Please sign within box with black ink. Signed:

Date: ________________________________ Page 7 of 8

FOR OFFICE USE ONLY

Receipt No. Amount Date of Admission Membership No. Initial

: : : : :

Date: _____________________________________ _____________________________________ _____________________________________ _____________________________________

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