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Online Registration Form - Become LIC Agent

Online Registration Form

Home Online Registration Form

Online Registration Form

Applicant Full Name*

Marital Status*



Your Email*

Date of Birth*



Preferred Language*

Your Location*

PIN Code*

Father / Husband Name*

Father / Husband Occupation*

Give name and address of two responsible persons ( not relatives or employees of the Corporation) for the purpose of reference

Reference-1 Details*

Reference-2 Details*

Exam Language*

Exam Center*

Document Upload

10th Marksheet or Certificate*

12th Marksheet or Certificate

PAN Card*

Photograph (Passport Size)*

Signature (Scanned)*

Address Proof (Aadhar Card, Voter ID, Electricity, Telephone, Post Paid Mobile Phone, Piped Gas, Water Bill)*