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AGENTS PROFILE

*) Name of the Agent

:- ___________________________________________________

*) Agency Code No.

:- ___________________________________________________

*) Agency Year End Month :- ___________________________________________________


*) Licence No.

:- ___________________________________________________

*) Licence Expiry Dt.

:-___________________________________________________

*) Mobile No.

:-___________________________________________________

*) Alternate Phone No.

:-___________________________________________________

*) Date of Birth

:- ___________________________________________________

_________________________________
LAST YEAR 2011-12

THIS YEAR 2012-13

*) No. of Policies

:-_____________________

____________________

*) Sum assured

:-_____________________

____________________

*) Total FPI

:-_____________________

____________________

*) Total commission

:-_____________________

_____________________

*) Club membership

:-______________________

_____________________

*) Policies above 25 lakhs

:- ______________________

____________________

*) Policies from 10 to 25 lakhs :-_____________________

_____________________

*) Policies from 5 to 10 lakhs :-_____________________

_____________________

BALAJI SHELKE
DEVELOPMENT OFFICER

____________________

LATUR 945 BO

(SIGNATURE OF THE AGENT).

9422071257 / 229177 / 222177.

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