REQUIRED DOCUMENTS

Candidate Name: MALINI H R Date: 10/12/2020

Mobile No: 9036162130

You will be required to submit the below mentioned documents before collecting the Offer Letter.

CHECKLIST
Put a tick mark if
# Document Name Comments
attached
1 Checklist
2 Employment Application Form
3 Letter of Authorization
4 Last Five years' Address Form For Address Verification
5 Undertaking Fill only If Passport is unavailable
6 10th marksheet
7 12th or PUC marksheet
Graduation - Marksheets of all 8 semesters OR
8
Transcript that has marks of all 8 semesters
9 Graduation Certificate or Provisional Degree Certificate
Post Graduation - Marksheets of all 8 semesters OR
10 Mention NA if you have not done
Transcript that has marks of all 8 semesters
11 Post Graduation Certificate or Provisional Degree Certificate Mention NA if you have not done
12 Three Months Payslip of Current Company (If Any) Mention NA if you don’t have any prior experience
13 Current Offer Letter or Recent Hike Letter Mention NA if you don’t have any prior experience
14 All Companies Work Experience Letters (If Any) Mention NA if you don’t have any prior experience
15 Passport - First and Last Pages Fill Undertaking Form if Passport is unavailable/expired
16 PAN Card Attach application acknowledgement if PAN unavailable
You can download Aadhaar with full date of from the following
link: https://eaadhaar.uidai.gov.in/#/
17 Aadhar Card (containing Full Date of Birth)
If your mobile number is not updated then reachout to
nearest Aadhaar correction center for correction and
share the Acknowledgement Copy with us.
Note: Filled forms and documents must be sent in sequential order as per the above checklist serials in PDF format and in one single PDF file

Documents submission is a part of the selection process and is not a a confirmation of your final selection. Allstate Recruitment Team will keep you
posted on the further course of action.

For any queries regarding the candidature please contact your recruiters below:

Recuitment Name:

Email ID:

Mobile No:
 Employment Application Form

 Please provide complete and correct information

 All fields are mandatory
 Please do not use short forms / abbreviations

Notice Period: Total Experience (in Months):

Mention your full name as per the Aadhaar Card – As the same would be used in our Employment records:
Personal Details

Ms. Malini H R
Title (Mr./Ms.) First Name Middle Name Last Name
Full Current Address: Full Permanent Address:

State: Karnataka Pin: 560073 State: Karnataka Pin:560073

Phone No: 9036162130 Phone No: 9036162130
E-mail ID 1: [email protected] E-mail ID 2: [email protected]
Maiden Name (applicable for married ladies): No
Father’s Name: Rajanna Mother’s Name: Gangamma
Nationality: Indian Blood Group: B(Negative)
Place of
Gender Date of Birth State of Birth Marital Status
Birth
 Male  Female 17/04/1997 Bengaluru Karnataka No
ID Yes/No ID Number Issue Date Valid up to
Govt. ID Proofs

Passport Yes U2798417 18/11/2020 17/11/2030

PAN Card Yes FZPPM0886K - -
Aadhar Card Yes 920693016527 - -
Driving License No - - -
Voter’s ID Yes XTE5809447 - -

Valid Visa:  Yes  No Denied Visa:  Yes  No

Date of Rejection: Country:
Country: Reason:

Emergency Contact Details

Name: Name:
Relationship: Relationship:
Contact Number: Contact Number:

v 1.0 Page 1 of
4
 School/University/ Part time / %/
Qualification Degree From To
Education Details

Board Full Time CGPA

Post Graduation

Graduation

12th (PUC)

SSLC/ 10th Std

Others

State reasons for gap in education (if any):

Do you know anyone working in Allstate presently, if yes please list them below:

Name Employee ID Relationship Designation

Technical Details

Platforms worked On

Operating systems used

Programming Language known

What are your career objectives

Refer your friends to Allstate:

Name Skill Contact Number Email ID

 Dependent Details for Medical Insurance

Direct Dependents
Full Name Gender Relationship Date of Birth Communication Address

Spouse

Child 1

Child 2

Parental Medical Insurance (you may choose either parents or In-laws)

Full Name Gender Relationship Date of Birth Communication Address

 Work Experience Details (mention NA if you don’t have prior experience)

From To Reason for

Organization Designation
(dd/mm/yy) (dd/mm/yy) Leaving

yment Application Form is true and correct and I understand that omission or misrepresentation of any fact may result in refusal of can

Place:

Date: Signature:
 Letter of Authorization

To whom it may concern

I understand that Allstate Solutions Private Limited. may use an outside agency to verify and validate the
information I have provided including my employment, my personal background, professional standing,
work history and qualifications.

I understand that an outside background agency may obtain information it deems appropriate from
various sources including, but not limited to, the following: current and past employers, criminal conviction
records, school records, College records and professional and personal references.

I authorize, without reservation, any individual, corporation or other private or public entity to furnish
Allstate Solutions Private Limited and the outside background agency all information about me.

I unconditionally release and hold harmless any individual, corporation, or private or public entity from any
and all causes of action that might arise from furnishing to All State and the outside agency information
that they may request pursuant to this release.

This authorization and release, in original, faxed or photocopied form, shall be valid for this and any future
reports and updates that may be requested.

Signed:

Name in Block Capitals:

Date:
 Last 5 years Address

Full Name – Date of birth:-

Father’s Name -

Address:1 Address:2
_______________________________________ _________________________________________

________________________________________ ________________________________________

_______________________________________ _________________________________________

________________________________________ ________________________________________

Landmark:____ _ _ _ Pin: ____ _ _ Landmark:____ _ _ _ Pin: ____ _ _

State: ________ __________________ State: ________ __________________

Period of Stay: __________________________ Period of Stay: __________________________

Address:3 Address:4

_______________________________________ _________________________________________

________________________________________ ______________________________________ __

_______________________________________ _________________________________________

________________________________________ __________________________________________

Landmark:____ _ _ _ Pin: ____ _ _ Landmark :______ _ _ _ Pin: ______ __

State: ________ __________________ State: ________ __________________

Period of Stay __________________________ Period of Stay: __________________________

Note:-

 Please share complete address with landmark and Pin code.

 Take additional print and update address details to add addresses if any
 UNDERTAKING

1. The company is at liberty to obtain a declaration from the employees that they do
not hold any passport, or the period of passport issued to them has expired and they
have not got it renewed. The PF department might have suggested declaration with
regard to passport just to ensure that the company will be in a position to ascertain
whether the new employee is an international worker for EPF purpose or is a
domestic employee.

2. The above declaration may be a part of prescribed application for appointment and
be completed as a matter of joining formality. The declaratory column in the
application for appointment may read as under:

“I hereby declare that I am an Indian citizen and hold only Indian passport. I do not
hold any other passport, or I do not hold any passport issued by the Indian
Authorities or from any other Country. I also confirm that I had no passport, or the
passport issued to me by (Country) has expired and I have not renewed the same.

Regards, Date

(Signature)

Name