Welcome to CDSL IR

Version 1.12.1

eIA Registration

eInsurance Account (eIA) Opening Form (For Individuals Only)

Note : Fields marked with asterisk (*) are compulsory

eIA-Service*

PAN**

and/or

UID**

Mobile No.*

Date of Birth*

Primary Email ID*

Applicant Details

First Name*

Middle Name

Last Name

Gender*

Male FemaleOther

Applicant Status*

Father/Spouse Name

Correspondence Address

Address Line 1*

Address Line 2

Address Line 3

Landmark

Country*

State*

City*

Pincode*

Other Details

Date of Receipt*

Alternate Email ID

Fax No.

Permanent Address Same as above

Address Line 1

Address Line 2

Address Line 3

Landmark

Country

State

City

Pincode

Bank Details

Account Number

Bank Name

Other Bank Name

Branch Name

State

City Name

Pincode

MICR Code

(MICR Code is Compulsory in case of ECS and ECS is 'No')

IFSC Code

(IFSC Code is Compulsory in case of NEFT)

Authorised Representative Details

Relationship with eIA holder

Other Relationship

AR Name

Gender

MaleFemaleOther

Date of Birth

PAN

UID

Mobile No.

Email ID

Address of Authorised Representative

Same as elA applicant Permanent Correspondence

Address Line 1

Address Line 2

Address Line 3

Landmark

Country

State

City

Pincode

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