FORM –IRDA-15
QUARTERLY REPORT- FORMAT FOR DAILY DIARY
(REG 16(3))
Important Instructions:
FORMAT FOR DAILY DIARY
(TO BE MAINTAINED BY TRAINER SURVEYOR AND SUBMITTED ONLINE IN SOFT FORM ON QUARTERLY BASIS)
Report for the Quarter ending: _______________(MM/YYYY)
1. Name of Trainee ….………………………….
2. Address ……………………………..
3. Communication
Phone Office
Phone Res.
Fax
Mobile
Email ID
Alternate Email ID
4. Name of Trainer Surveyor / Surveyor Firm: ……………………………..
Current License No ……………………………..
Date of expiry ……………………………..
Membership Details
Dept
Fire
Marine cargo
Marine Hull
Engg
Motor
Misc
Crop Insurance
LOP
Level of Membership
Date of commencement of training : ……………………………..
Department
Contents of training imparted (Upload in soft form and Attach supporting documents wherever possible)
SIGNATURE OF TRAINER
Date:
Place: