PoSP Registration Form

* All fields are mandatory

Personal Details

First Name *

Last Name *

Gender *

Male Female

Date of Birth *

Mobile *

Alternate Mobile

Email *

Address *

State *

City *

PIN Code *

Aadhaar No. *

PAN *

Highest Qualification *

Bank Name *

Bank Address *

Account Number *

IFSC Code*

Aadhaar Card Front Side* Clear

Aadhaar Card Back Side* Clear

PAN Card* Clear

Highest Qualification Cert.* Clear

Cancelled Cheque* Clear

Profile Photo Clear

Reference

NIRVIANN INSURANCE BROKERS PRIVATE LIMITED Office address :- 827, 8th Floor Vikas Deep Building Laxmi Nagar East Delhi, 110092

Licence Number-854, IRDAI Broker Code :- IRDAI/DB949/2022, Valid Till Date :- 11/10/2025, Principal officer's name :- Gaurav Pathania