Life Insurance Agents' Federation of India
Regd. No. 2924/2000
Application for Registration as delegate for the 18th General Council Meeting at Vijayawada to be held on 7th, 8th & 9th of Dec. 2026.
Receipt / Reg No.
Date
Delegate / Observer Category
Zone
Division
Branch
SO Branch -
Present Post in LIAFI: Member
Payment Method: CASH
Affix Passport size
Photo Here
Photo Here
Application for Registration as delegate for the 18th General Council Meeting of Vijayawada
to be held on 7th, 8th & 9th of Dec. 2026.
To,
Sri B. MARKANDEYULU
Secretary General, LIAFI / Chairman-Reception Committee
1-4-77/1, GSR Residency - II, Gujjanagundla, GUNTUR - 522 006 A.P.
Mob. : 09885453688, E-mail : bhimisetty688@gmail.com
Dear Sir,
I am remitting a sum of Rs. 3000
(Rupees in words) Three
Thousand Only only through NEFT.
Bank Details : LIAFI, Canara Bank ; IFSC Code : CNRB0013341,
Account No. 120042269002, Please enroll me as a delegate / observer for the 18th
General Council of LIAFI to be held from 07-12-2026 to 09-12-2026
| 1 | Delegate / Observer Fee without Accommodation | Rs. 3000/- |
| 2 | Donation | Rs. 0/- |
| 3 | Transcation No. : | Total: Rs. 3000/- |
> [ ] I am not attending due to personal reasons but I am
transferring Rs.
towards donation. Please send me the resolutions passed by the 18th General Council Meeting
and other information
| Delegate / Observer Details | |||
|---|---|---|---|
| Name | Agency Code No. | ||
| House No. | Agent Type | Full Time Agent | |
| Street | Agency held since past : | ||
| Post Office | Name of Branch | ||
| District | Name of Div | ||
| State | Zone | ||
| Pin Code | Are you a Patron Member | No | |
| Mobile No. | Email : | ||
I assure to abide by the Rules and Regulation of LIAFI.
Signature:
Date:
Place:
★ LIAFI ★
Regd. No.
2924/2000
Visakhapatnam
Note : This form along with Registration Fee must reach by 30th Nov 2026.