Please Provide Complete and Correct Information

MPHASIS - IT

Employee Verification Form

Applicant No/ Client Reference Entity Designation Employee ID Number Delivery GGIT  2269667 Module Lead GGIT – USA  KFIT  DSC  JPMC New 

 Please provide complete and correct information.  All fields are mandatory.  Please do not use short forms / abbreviations.  Please refer to page 12 for documents & information required

Personal Details

Title (Mr. / Mrs. / Ms.) Mr.

Last name First name Middle name Pandey Ashutosh Kumar

Nationality Indian Date of Birth (yy/mm/dd) 80/03/01 Place of Birth Chapra, Bihar US Social Security Number (If applicable)

Marital Status: Married Gender: Male Contact Telephone No. Office Tele No. Mobile / Pager Email Address 9958214943 9958214943 9958214943 [email protected] Family Details

Name of Father: (Last name) (First name) (Middle name)

Pandey Shila Nath

Address: At-Raja Chapra, PO-Badlu tola, PS-Chapra Contact Telephone No. Mufassil, Dist- Saran, Pin - 8414114 (09939714968 )

Next of Kin: (Last name) (First name) (Middle name)

Pandey Priti

Address: A/3, 203,Gayatri Residency,Medatiya Contact Telephone No. Nagar,Opp - Seven Square Academy, Deepak ( 9015843903 ) hospital lane, Mira Road East, Thane-401107

Passport Details If applied for one

Do you have a valid Passport? File number in passport application:

Yes  No  ARN:170003905294 Appointment is fixed on 15 Mar. So I will update File number after the appointment.

Passport number:

Name as in passport

Date of Birth (yyyy/mm/dd)

Place of residence (if shown)

Date of issue (yyyy/mm/dd)

Place of issue

Expiry date (yyyy/mm/dd)

2 Identity Details

Primary Documents to be attached (Any two)

Passport Number: Date of expiry:

Driving License Number: Date of expiry: Number: AZCPP2977N Place of issue: Applied in Delhi and it was delivered at my permanent address Chapra, PAN Card Bihar

Election ID card Number: IPS2241008 Place of issue: Delhi

Secondary Documents to be attached if primary documents are not available

Marriage Certificate Number: Place of issue:

Secondary School Leaving Certification Seat Number: Year of passing

Birth Certificate Number: Place of issue:

Notarized affidavit (with photo, fathers name & occupation, residence address and citizenship)

3 Address Details

Current Residential A/3,203,Gayatri Residency, Medatiya Nagar, Opp Seven Square Address academy, Mira Road East, Thane-401107

Deepak Hospital lane Prominent Landmark

Contact Details Res. Number: A/3,203 Mobile Number: 9958214943 Exact period of stay at current address From: 01 Nov, 2015 To: till date Kindly indicate a convenient time for a 9AM to 5PM physical address verification Previous Addresses (Covering last 5 years)

K-304,Grand Manor Ideal park, Deepak hospital lane,Mira Road east, Previous Address 1 Thane-401107

Landmark Deepak Hospital Lane

Period of Stay From: 30/11/2014 To: 30/10/2015

Contact Details Res. Number: K-304 Mobile Number: 8087673250 B/107,Queens Avenue, Queens Park, Behind Deepak Hospital, Mira Previous Address 1 Road East Thane-401107

Landmark Deepak Hospital

Contact Details Res. Number: B/107 Mobile Number: NA(society office will prove) C-103, Shri ji Apartment, building-2, Kishore Nagar, Nilegaon, Nalasopara West, Previous Address 1 Mumbai- 401203.(I stayed here with Ratnesh Mishra(mob.9987422607) who was already residing there )

Landmark Sanjay Gandhi School

Contact Details Res. Number: C-103 Mobile Number: 9987422607

4 Previous Address 1 B-35A, Second floor, Gali No- 3, South Ganesh Nagar,Delhi-92 (My some family members are still residing at the address.) Landmark Mother Dairy

Contact Details Res. Number: B-35A Mobile Number: 8010572703 Education Details

Highest Educational Qualification

Please ensure copy of degree certificate and mark sheet are attached

Name of the University Indira Gandhi National Open University

College Name Saint Xavier school, Patna(Study center of IGNOU)

University Address Maidan Gadhi, New Delhi(IGNOU Head Office)

College Address West Gandhi Maidan Marg, Patna - 800001

From To Graduated Program % / Class Student ID (month/yr) (month/yr) No./Enrolment No.

Jan/2004 Jun/2008 MCA  Full Time- 59.39 / 040190088 NO second division  Part Time -YES

Type of degree, certificate, Graduation date (month/yr) Subject Major diploma:

MCA Jun/2008(exam held in Jun Computer Science 2008) Result announced in (Aug/2008)

Copy of the certificates attached? Yes

5 Employment Details

Details of current / latest employer

(In descending order covering last 5 years) Company Position Held Delivery Module Lead Name: (1) Mphasis Limited & Department EMSBU

Address (main office where worked): Telephone:

Mphasis Limited, Wing-B,1st floor,Infinity It 02267883000 park, building no-4,General AK Vaidya marg, Dindoshi, Malad East,Mumbai- 400097,India Employment Period: (date, month, year) Employee Code: Supervisor’s Full Name Anuradha 2269667 Designation: From: 03/03/2014 Off no. Ext: To: till date Cell no. 9731230193 Res no. Whether employment is of permanent or temporary nature -  Permanent  Temporary

Agency Details (if temporary or contractual)

Address: Responsibilities: Design and development

Last salary drawn per month Reason(s) for Leaving:

CTC : per month Gross : per month Net : per month Can a reference be taken now? Yes / No

6 If no, when can it be taken?

** Fill in as much detail as possible and attach all documents. Details of Previous Employer (2) Company Ascent Cyber Solutions Position Held Senior Software Engineer Name: (located in pune) & Department IT

Address (main office where worked): Telephone: Worked in NOIDA for: Pitney Bowes Software India Pvt Ltd. Noida,Sec-62 Employment Period: (date, month, year) Employee Supervisor’s Full Name Code: Pavan Rathore Designation: PM From: 05/02/2013 1056 Off no. Ext: Cell no. 9881132045 To: 12/02/2014 Res no. Whether employment is of permanent or temporary nature -  Permanent  Temporary

Responsibilities: Designing and Coding

Last salary drawn Reason(s) for Leaving:

CTC : 53390(Rs.) per month For career growth Gross : per month Net : 47601(Rs.) per month

** Fill in as much detail as possible and attach all documents.

7 Details of Previous Employer (3) Company SDG Software India Pvt. Ltd Position Held Software Engineer Name: & Department Technology

Address (main office where worked): Telephone: SDG Software India Pvt Ltd. A-10,Sec-2,Noida Employment Period: (date, month, year) Employee Supervisor’s Full Name Code: Rajneesh Mishra Designation: Technical From: 06/12/10 2262 Architect

To: 01/02/2013 Off no. Ext: Cell no. 8527698429 Res no. Whether employment is of permanent or temporary nature -  Permanent  Temporary

Responsibilities:

CTC : 32248(Rs.) per month For career growth Gross : per month Net : 32248(Rs.) per month

8 Details of Previous Employer (4) Company Position Held Name: & Department

Address (main office where worked): Telephone:

Employment Period: (date, month, year) Employee Supervisor’s Full Name Code: Designation: From: DD/MM/YY Off no. Ext: To: DD/MM/YY Cell no. Res no. Whether employment is of permanent or temporary nature -  Permanent  Temporary

Responsibilities:

CTC : per month Gross : per month Net : per month

9 GAPS

Please account for all gaps in employment during the last five years.

From To Reason:

10 Letter of Authorization

To whom it may concern

I hereby authorize MphasiS and its representative to verify information provided in my resume and application of employment, and to conduct enquiries as may be necessary, at the company's discretion. I authorize all persons who may have information relevant to this enquiry to disclose it to MphasiS or its representative. I release all persons from liability on account of such disclosure.

Sign : Ashutosh kr pandey

Name in Capitals : ASHUTOSH KUMAR PANDEY

Date : 11/03/2017

11 Mandatory Documents \ information required:

For Education Verification:

1. Copies of the Marks Sheets/Grade Card for all the years of attendance. 2. A photocopy of both the sides of the Degree Certificate (The reverse side of the certificate has information which the University requires). 3. Name and address of the College \ University through which the candidate has graduated.

For Employment Verification

1. Complete name of the employer along with the address and contact numbers 2. Employee code 3. Supervisor full name, designation and direct contact numbers 4. Relieving letter / Experience Letter / Service Certificate

For Identity Verification:

Photocopies of Primary Documents (Minimum of two – Passport is mandatory and the other one is any one of Election ID, Driving License or PAN Card)

1. Current Passport copies – first & last sheet. Also, copies of other sheets (if any stamping is there) 2. Election ID card 3. Driving License 4. PAN Card

Secondary Documents: (If primary documents not available)

1. Birth Certificate 2. Marriage Certificate (if applicable) 3. Last 2 months Bank Statement 4. Last 2 months Credit Card Statement

For Address Verification:

1. Complete address to include, house number - lane number (where applicable), town, district, state, pin code number, etc. 2. Prominent landmark 3. Land line number 4. Period of Stay

Original color photographs (2 numbers)

Current address proof (passport copy, electricity bill, telephone bill, Credit card statement, PAN card) For Criminal Verification refer to the list provided by HR.