Aapt Outsourcing Solutions Pvt. Ltd.

Personal Information Form

Referred By: ________________________________________

Position & Company Applied For: _________________________________

Passport Size Photo

Personal Information

Particulars
Details Particulars Details

Name Mr. /Ms

Marital Status:

Date of Birth of
Employee Contact No.:

Emergency Contact
Father’s DOB/ Age
Number

Mother’s Name & PAN CARD No:

DOB/ Age

Aadhar Card No
Blood Group
Bank Account Number
IFSC code :
:
Bank & Branch Name
Date of Marriage

Permanent Address Correspondence

Address
Total Years of
Driving License (DL)
Experience in Years
No

Page 1 of 2
 Aapt Outsourcing Solutions Pvt. Ltd.

Educational Qualification
Qualification (Chronological order-please start from the most recent qualification)
Part Time/Full Year of
Degree/Diploma Division
Board/Univ./Institute Subjects Time Passing (%age)

Employment History
Sl.No Company Name Designation Duration (From-To) Reporting To

General Information
Give reference of 2 persons with or under whom you have worked:
Name Company Designation Contact No.

DECLARATIONS:

Have you at any time during the period of last five years been convicted anytime by a court? Yes/No

If yes, details

Are any criminal proceedings pending against you before the court in India/abroad?

Yes/No If yes, details

The information provided by me in this form is true and I am solely responsible for its accuracy. Post-
employment with Aapt Outsourcing Solutions, if anything contrary to the above declaration is found out, the
organization could call off my appointment without any prior notice.

Date:

Place: Signature

Page 2 of 2
 ?kks"k.kk i=k DECLARATION FORM QkeZ&1@Form-1
?kks"k.kk i=k deZpkjh }kjk Hkjk tk,xkA QkeZ ds LkkFk iksLVdkMZ vkdkj ds nks QksVksxzkQ Hkh yxk, tkus pkfg,A QkeZ Hkjus ls igys
ihB i`"B ij nh xbZ fgnk;rksa dks Hkyh&Hkkafr i<+ ysuk pkfg,A ;g QkeZ fu%'kqYd gSA
To be filled by employee after reading instruction overleaf. Two Postcard Size phtographs to be attached with the
form. This form is free of cost.
¼d½ chekÑr O;fDr ds fooj.k ¼[k½ fu;kstd ds fooj.k
(A) INSURED PERSON'S PARTICULARS (B) EMPLOYER'S PARTICULARS

1- chek la[;k@Insurance No. 9- fu;kstd dh dwV la[;k

Employer's Code No.
2- uke ¼Li"V v{kjks esa½
Name in block letters
10- fu;qfDr dh rkjh[k fnu eghuk o"kZ
Date of Appointment Day Month Year
3- firk@ifr dk uke
Father's/Husband's Name 11- fu;kstd dk uke vkSj irk@Name & Address of the Employer
4- tUe dh frfFk fnu eghuk o"kZ 5- oSokfgd fookfgr@ __________________________________________________
Date of Birth Day Month Year izkfLFkfr vfookfgr __________________________________________________
Marital fo/kok __________________________________________________
Status M/U/W 12- ;fn igys fu;kstu esa jgs gSa rks Ñi;k fuEufyf[kr C;kSjs nhft,
6-fyax@Sex iq-e-/M.F. In case of any previous employment please fill up the details as under.

7- orZeku irk@Present Address 8- LFkk;h irk@Permanent Address ¼d½ fiNyh chek la[;k
______________________ ______________________ (a) Previous Ins. No.
______________________ ______________________ ¼[k½ fu;kstd dwV la[;k
______________________ ______________________ (b) Employer's Code No.
fiu dksM fiu dksM
Pin Code Pin Code ¼x½ fu;kstd dk uke o irk
VsyhQksu uEcj@bZ&esy irk@ VsyhQksu uEcj@bZ&esy irk@ (c) Name & Address of the Employer

'kk[kk dk;kZy; vkS"k/kky;

Brach Office Dispensary
VsyhQksu uEcj@bZ&esy irk@e-mail address
¼d½ e`R;q dh fLFkfr esa udn fgrykHk ds Hkqxrku ds fy, d-jk-ch- vf/kfu;e] 1948 dh /kkjk 71@d-jk-ch- ¼dsUnzh;½ fu;e] 1950 ds fu;e 56¼2½ ds varxZr ukfer ds C;kSjsA
(c) Details of Nominee u/s 71 of ESI Act 1948/Rule-56(2) of ESI (Central) Rules, 1950 for payment of cash benefit in the event of death.

uke@Name ukrsnkjh@Relationship irk@Address

eSa ,rn~}kjk ?kks"k.kk djrk@djrh gwa fd esjs }kjk izLrqr fd, x, fooj.k esjh tkudkjh vkSj fo'okl ds vuqlkj lgh gSA eSa vius ifjokj ds lnL;ksa esa gq, ifjorZu dh lwpuk
15 fnu ds Hkhrj izLrqr djus dk opu Hkh nsrk gwa@nsrh gwaA
I hereby decalare that the particulars given by me are correct to the best of my knowledge and belief. I undertake to intimate the corporation any
changes in the membership of my family within 15 days of such change.

fu;kstd ds izfrgLrk{kj chekÑr O;fDr ds gLrk{kj@vaxwBk fu'kku

Counter signature by the employer Signature /T.I.of IP.

lhy lfgr gLrk{kj

Signature with seal
¼?k½ chekÑr O;fDr ds ifjtuksa dk fooj.k
(D) Family Particulars of Insured person
Ø-la- uke QkeZ Hkjus dh rkjh[k deZpkjh ds lkFk ukrsnkjh D;k muds lkFk jg ;fn ugha rks vkokl
SI. No. Name dks vk;q@tUe&rkjh[k Relationship with the jgs gSa\ crk,a dk LFkku n'kkZ,a
Date of Birth/Age as on Employee Whether residing If' No' state Place of
date of filling form with him/her. Residence
gk¡@Yes ugha@No dLck@Town jkT;@State

d-jk-ch- fuxe vLFkk;h igpku i=k ¼fu;qfDr dh rkjh[k ls 3 eghus rd oS/k½

ESI Corporation Temporary Identity Card (Valid for 3 month from the date of appointment)
uke@Name
chek la[;k@Ins. No. fu;qfDr dh rkjh[k@Date of appointment
'kk[kk dk;kZy; vkS"k/kky; QksVks ds fy, LFkku
Branch Office Dispensary (Space for photograph)

fu;kstd dh dwV la[;k o irk

Employer's Code No. & Address

oS/krk
Validity
rkjh[k chekÑr O;fDr ds gLrk{kj@vaxwBs dk fu'kku lhy lfgr 'kk[kk izca/kd ds gLrk{kj
Dated Signature/T.I. of I.P. Signature of B.M. with seal
 vuq n s ' k
INSTRUCTIONS

1- QkeZ&1 dk izs"k.k d-jk-ch- ¼lk/kkj.k½ fofu;e] 1950 ds fofu;e 11 o 12 ds varxZr fofu;fer fd;k tkrk gSA
Submission of Form-I is governed by regulation 11 & 12 of ESI (General) Regulations, 1950

2- ßdqVqEcÞ ls fdlh chekÑr O;fDr ds fuEufyf[kr lHkh vFkok dksbZ ukrsnkj vfHkizsr gS%&
vFkkZr~%& ¼1½ fookfgrh ¼2½ chekÑr O;fDr ij vkfJr dksbZ /keZt ;k nÙkd vo;Ld vkfJr ckyd] ¼3½ dksbZ ckyd tks chekÑr O;fDr
ds miktZuksa ij iw.kZr% vkfJr gS rFkk tks ¼d½ f'k{kk izkIr dj jgk gS] muds 21 o"Z dh vk;q izkIr dj ysus rd ¼[k½ dksbZ vfookfgr iq=kh]
¼4½ dksbZ ckyd tks fdlh 'kkjhfjd vFkok ekufld vilkekU;rk ;k pksV ds dkj.k f'kfFkykax gS rFkk f'kfFkykaxrk jgus rd chekÑr O;fDr
ds miktZuksa ij iw.kZr% vkfJr gS] ¼5½ vkfJr ekrk&firk] ¼C;ksjs gsrq d-jk-ch- vf/kfu;e] 1948 dh /kkjk 2 ds [kaM 11 dks ns[ksa½A
“Family” means all or any of the following relatives of an Insured Person namely:-

(i) a spouse (ii) a minor legitimate or adopted child dependant upon the I.P.; (iii) a child who is wholly dependant on the
earnings of the I.P. and who is (a) receiving education, till he or she attains the age of 21 years (b) an unmarried daughter;
(iv) a child who is infirm by reason of any physcial or mental abnormality or injury and is wholly dependant on the earnings
of the I.P. so long as the infirmity continues; (v) dependant parents (Please see Section 2 clause 11 of the ESI Act 1948 for
details.

3 igpku&i=k vgLrkUrj.kh; gSA

Identity Card is Non-Transferable.

4- igpku&i=k ds xqe gksus dh fLFkfr esa fu;kstd@'kk[kk izca/kd dks rRdky lwfpr fd;k tk,A
Loss of Identity Card be reported to Employer/Branch Manager immediately.

5- fdlh izdkj dh xyr lwpuk nsus dh fLFkfr esa d-jk-ch- vf/kfu;e] 1948 dh /kkjk&84 ds rgr dkuwuh dk;Zokgh dh tk ldrh gSA
Submission of false information attracts penal action Under Section 84 of ESI Act. 1948.

6- ubZ fu;qfDr dh fLFkfr esa Hkyh&Hkkafr Hkjk gqvk ;g QkeZ fu;qfDr ds nl fnu ds Hkhrj lacaf/kr 'kk[kk dk;kZy; esa vo'; gh izLrqr fd;k
tkuk pkfg,A foyEc dh fLFkfr esa fu;kstd ds fo#) /kkjk&85 ds rgr dkuwuh dk;Zokgh dh tk ldrh gSA
This form duly filled in must reach the concerned Branch Office within 10 days of appointment of an Employee. Delay
attracts penal action under Section 85 of the Act, against employer.

7- chekÑr O;fDr gksus ds ukrs vki o vkids ifjokj ds vkfJrtu fpfdRlk fgrykHk izkIr dj ldsaxsA vU; udn fgrykHk gSa] ¼1½ chekjh
fgrykHk ¼2½ vLFkk;h viaxrk fgrykHk ¼3½ LFkk;h viaxrk fgrykHk ¼4½ vkfJrtu fgrykHk ¼5½ izlwfr fgrykHk ¼efgyk deZpkjh ds fy,½A
As an insured person you and your dependant family membes are entitled to full medical care. The other benefits in cash
include (1) Sickness Benefit (2) Temporary Disablement benefit (3) Permanent disablement Benefit (4) Dependants benefit
and (5) Maternity Benefit (in case of woman employees) subject of fulfillment of contributory cnditions.

8- vf/kd tkudkjh ds fy;s Ñi;k fuxe ds osclkbV dks nsa[ksa ;k 'kk[kk dk;kZy; ;k {ks=kh; dk;kZy; ls laidZ djsaA
For more details please contact website of ESIC at www. esic.org. in. or contact Regional Office or Branch Office.

dsoy 'kk[kk dk;kZy; esa iz;ksx gsrq

For Branch Office Use only

1- chek la[;k vkoaVu dh rkjh[k %

Date of allotment of Ins. No. :_________________________________________

2- vLFkk;h igpku i=k tkjh djus dh rkjh[k %

Date of Issue of T.I.C. :______________________________________________

3- vkS"k/kky; dk uke@la[;k %
Name /No. of Dispensary : ___________________________________________

4- D;k vU;ksU; fpfdRlk O;oLFkk miyC/k gS\ ;fn gkaa] rks mYys[k djsa %
Whether reciprocal Medical arrangements involved. if yes, please indicate :

'kk[kk izcU/kd ds gLrk{kj

Signature of Branch Manager

Ø-la- uke QkeZ Hkjus dh rkjh[k deZpkjh ds lkFk ukrsnkjh D;k muds lkFk jg ;fn ugha] rks vkokl
SI. No. Name dks vk;q@tUe&rkjh[k Relationship with the jgs gSa\ crk,a dk LFkku n'kkZ,a
Date of Birth/Age as on Employee Whether residing If' No, state Place of
date of filling form with him/her. Residence
gk¡@Yes ugha@No dLck@Town jkT;@State
 THE PAYMENT OF GRATUITY (CENTRAL) RULES, 1972

FORM F
[See sub-rule (1) of Rule 6]
Nomination
To

1. Shri/Shrimati/Kumari_________________________________ whose particulars are given in the

statement below, hereby nominate the person(s) mentioned below to receive the gratuity payable
after my death as also the gratuity standing to my credit in the event of my death before that amount
has become payable or having become payable has not been paid and direct that the said amount
of gratuity shall be paid in proportion indicated against the name(s) of the nominee(s).

2. I hereby certify that the person(s) mentioned is /are member(s) of my family within the meaning of
clause (h) of Section 2 of the Payment of Gratuity Act, 1972.

3. I hereby declare that I have no family within the meaning of clause(h) of section 2 of the said Act.

4. (a) My father/mother/parents is/are not dependent on me.

(b) My husband’s father/mother/parents is/are not dependent on my husband.

5. I have excluded my husband from my family by a notice dated the________________to the

Controlling Authority in terms of the proviso to clause(h) of Section 2 of the said Act.

6. Nomination made herein invalidates my previous nomination.

NOMINEE(S)

Name in full with Relationship Age of nominee Proportion by

Full address of with the which the gratuity
Nominee (s) employee will be shared
1 2 3 4
 THE PAYMENT OF GRATUITY ( CENTRAL RULES, 1972 )

STATEMENT
1. Name of employee in full :
2. Sex :
3. Religion :
4. Whether unmarried/married/widow/widower :
5. Department / Branch/ Section where employed :
6. Post held with Ticket or Serial No., if any :
7. Date of appointment :
8. Permanent address :
Village…….………………………….Thana……...………………..…Sub-division…..…………...
Post office…………………………….District………………………..State………………………..

Place :………………… Signature / Thumb-impression

Date :……………….. of the employee

DECLARATION BY WITNESSES

Nomination signed / thumb impressed before me

Name in full and full address of witness Signature of witness

1.

2.

Place : …………………..

Date :…………………..

Certificate by the Employer

Certified that the particulars of the above nomination have been verified and recorded in this establishment.
Employer’s Reference No., if any.

Signature of the employer / officer authorized

Date :……………. Designation

Name and address of the establishment or rubber stamp thereof
Acknowledgement by the Employee

Received the duplicate copy of nomination in Form ‘F’ filed by me and duly certified by the employer

Date :………………… Signature of the Employee

Note : Strike out the words / paragraphs not applicable.

 DECLARATION CUM UNDERTAKING

I,____________, S/D/W of___________________ Resident of_____________ , do hereby

declare and affirm that:

1. I am taking up employment with Aapt Outsourcing Pvt. Ltd. (“Company”) and will be
joining with effect from _______.

2. I hereby declare and confirm that presently I am not doing any business or profession
nor employed with any firm, company or body corporate and am in no way restricted or
restrained from taking up employment with the Company.

3. Prior to joining this company, I was employed with______________________

(“Previous Employer”), where I resigned on __________and relieved from the services
with effect from _______________. I have completed my exit-formalities with my
previous employer, however; I have not received proper letter of relieving/ acceptance
of resignation.

4. I undertake that I will furnish proper documents of relieving from my previous employer
at the earliest but not later than within ___days of my joining with the Company and I
undertake be fully responsible in the event of any legal implication occurs in this regard.

Or I am unable to provide proper letter of relieving however, I undertake to be fully

responsible in the event of any legal implication occurs in this regard.

5. I also confirm that there are no legal proceedings, whether civil or criminal, pending
against me restraining me to take up employment with the Company.

6. I hereby certify that the statements contained herein are true and correct.

7. I unconditionally indemnify the Company from or against any and all claims, demands,
litigation, damages, penalties, costs or expenses of any kind whatsoever arising from or
in any manner related to breach of the above statements and/or if any of my above
statements are found to be untrue at any time in future, apart from this
indemnification, the Company shall have all rights to proceed against me and take any
action as it may deemed fit and proper, including, but not limited to, suspension or
termination of my employment with the Company with immediate effect i.e., without
giving any notice, and in such a case all my rights including any claim to salary and other
dues from the COMPANY may be withheld by the Company for adjustment against any
losses, damages etc. suffered by the Company for any of the above said reasons.

Name: ________________________ Sign: _____________

Date: ________________________ Place: _____________
 Joining Documents Checklists

Employee Name: Emp. Code:

Date of Joining: Client and deployment location:

List of Documents

Sr. No List of Documents Responsibility Priority Completed (Yes/No)

A To Be provided by Candidate

1. Candidate Resume On-Boarding Team High

2. Accepted Offer Letter On-Boarding Team High

3. New Hire Detail Form On-Boarding Team High

4. 4 Photographs On-Boarding Team High

5. PAN Card On-Boarding Team High

6. Aadhar Card On-Boarding Team High

7. Residential Proof (Electricity Bill/Driving License/Passport Copy) On-Boarding Team High

8. 10th/ 12th Certificate as DOB Proof On-Boarding Team High

9. Qualification Certificate – Grad & Post Grad if applicable On-Boarding Team High

10. Acceptance of Resignation or Relieving letter of previous organization. On-Boarding Team High

11. Last Three Months Salary Slip of Previous Organization On-Boarding Team High

B Document to be filed by Candidate

12. Provident Fund Form 11 On-Boarding Team High

13. Provident Fund Form 2 On-Boarding Team High

14. ESIC Form 1 On-Boarding Team High

15. Insurance Form On-Boarding Team High

Page 1 of 1
 Human Resources – Aapt Outsourcing Solutions Pvt. Ltd.

MEDICAL INSURANCE DECLARATION FORM

DETAILS OF EMPLOYEE (To be filled by Employee)

FULL NAME EMPLOYEE CODE

DESIGNATION GRADE

DEPARTMENT DATE OF JOINING (dd/mm/yyyy)

GENDER DATE OF BIRTH(dd/mm/yyyy)

MARITAL STATUS BLOOD GROUP

IMMEDIATE FAMILY DETAILS (To be filled by Employee)

Date of Birth
Name Relationship Gender Blood Group
(mm/dd/yyyy)

Wife / Husband

Children details
(Max-2)

Son/Daughter

Son/Daughter

EMPLOYEE NAME EMPLOYEE SIGNATURE

LOCATION DATE OF SUBMISSION

Please note that it is mandatory to provide DOB/Age details for all members to be covered under this policy.

Page 1
 FORM 2 (Revised)

NOMINATION AND DECLARATION FORM FOR UNEXEMPTED/

EXEMPTED ESTABLISHMENTS

Declaration and Nomination Form under the Employees’ Provident Funds and
Employees’ Pension Scheme

(Paragraphs 33 & 61 (1) of the Employees Provident Fund Scheme, 1952 and Paragraph 18 of the Employees’ Pension scheme, 1995)

1. Name (in Block letters) :

2. Father’s/Husband’s Name :

3. Date of Birth :

4. Sex :

5. Marital Status :

6. Account No. :

7. Address : Permanent :

Temporary :

PART – A (EPF)
I hereby nominate the person(s) /cancel the nomination made by me previously and nominate the person(s) mentioned below
to receive the amount standing to my credit in the Employees’ Provident Fund in the event of my death :

Name of
nominee/ Address Nominee’s relation- Date of Total amount of share of If the nominee is a minor,
nominees ship with the member Birth Accumulations in Provi- name & relationship & address
dent Fund to be paid to of the guardian who may
each nominee receive the amount during
the minority of nominee

1 2 3 4 5 6

1 * Certified that I have no family as defined in para 2(g) of the Employees’ Provident Fund Scheme, 1952 and should
I acquire a Family hereafter, the above nomination should be deemed as cancelled.

2 * Certified that my father/mother is/are dependent upon me.

Signature or thumb impression of the subscriber

*Strike out whichever is not applicable.

Form -2
 Part B (EPS) (Para 18)
I hereby furnish below particulars of the members of my family who would be eligible to receive widow/children pension
in the event of my death.

S.No. Name of the family Address Date of Birth Relationship with the member
member

1 2 3 4 5

** Certified that I have no family, as defined in para 2(vii) of Employees’ Pension Scheme, 1995 and should I acquire a family
hereafter I shall furnish particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension (admissible under para 16 2(a)(i) and (ii)
in the event of my death without leaving any eligible family member for receiving Pension.

Name and Address of the Nominee Date of Birth Relationship with the member

1 2 3

1.

2.

3.

4.

Date :
Signature or thumb impression
of the subscriber
Place :

**Strike out whichever is not applicable.

CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smt./Kum._____________________________

______________________ employed in my establishment after he/she has read the entries/entries have been read over to him/her

by me and got confirmed by him/her.

Place : ________________
Signature of the employer or other
Authoried Officers of the Establishment.

Designation
Dated the : ____________________

Name & Address of the Factory/

Establishment or Rubber Stamp Thereon

Form -2