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LIC Agency Online Application Form
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* Indicates required question
Full Name
*
Your answer
Mobile Number
*
Your answer
Email Address (Gmail is preferable)
*
Your answer
Category
*
Gen
SC
ST
OBC
Other:
Marital Status
*
Single
Married
Widowed
Divorced
Other:
Aadhaar Number
*
Your answer
PAN Card Number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Basic Education
*
10th/12th/Diploma/ITI? Mention your basic qualification only.
10th
12th
Diploma
ITI
Other Equivalent to 10th or 12th
Other:
Board Name of Basic Education (GSHEB/CBSE/Other)
*
Your answer
Roll Number of Basic Education
*
Mention the Roll number which is written on the marksheet of your basic education like 10th/12th or Diploma.
Your answer
Additional Qualification
Mention Your Graduation and Post Graduation Degrees (BE/Bcom/MBA etc.)
Your answer
Your Occupation
*
Business
Govt Service
Service in PVT Company
Profession (CA/Lawyer/Teacher/Doctor etc)
Homemaker
Other:
Name of the Employer (only in case if you are doing service/job)
Your answer
Name of Father/Husband
*
Your answer
Spouse/Father's Occupation
*
Business
Govt Service
Service in PVT Company
Profession (CA/Lawyer/Teacher/Doctor etc)
Other:
Name of the Employer (only in case if your spouse/father is doing service/job)
Your answer
Occupation of Father/Husband
*
Your answer
Name & Address of Responsible Person 1
*
Your answer
Name & Address of Responsible Person 2
*
Your answer
Exam Language
*
English
Hindi
Gujarati
Exam Centre (Which City?)
*
Your answer
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