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MPHASIS - ITEmployee Verification FormApplicant 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 requiredPersonal DetailsTitle (Mr. / Mrs. / Ms.) Mr.Last name First name Middle name Pandey Ashutosh KumarNationality 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 NathAddress: 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 PritiAddress: A/3, 203,Gayatri Residency,Medatiya Contact Telephone No. Nagar,Opp - Seven Square Academy, Deepak ( 9015843903 ) hospital lane, Mira Road East, Thane-401107Passport Details If applied for oneDo 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 passportDate of Birth (yyyy/mm/dd)Place of residence (if shown)Date of issue (yyyy/mm/dd)Place of issueExpiry date (yyyy/mm/dd)2 Identity DetailsPrimary 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 BiharElection ID card Number: IPS2241008 Place of issue: DelhiSecondary Documents to be attached if primary documents are not availableMarriage Certificate Number: Place of issue:Secondary School Leaving Certification Seat Number: Year of passingBirth Certificate Number: Place of issue:Notarized affidavit (with photo, fathers name & occupation, residence address and citizenship)3 Address DetailsCurrent Residential A/3,203,Gayatri Residency, Medatiya Nagar, Opp Seven Square Address academy, Mira Road East, Thane-401107Deepak Hospital lane Prominent LandmarkContact 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-401107Landmark Deepak Hospital Lane Period of Stay From: 30/11/2014 To: 30/10/2015Contact Details Res. Number: K-304 Mobile Number: 8087673250 B/107,Queens Avenue, Queens Park, Behind Deepak Hospital, Mira Previous Address 1 Road East Thane-401107Landmark Deepak HospitalPeriod of Stay From: 01/09/2014 To: 29/11/2014Contact 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 SchoolPeriod of Stay From: 02/03/2014 To: 31/08/2014Contact Details Res. Number: C-103 Mobile Number: 99874226074 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 DairyPeriod of Stay From: 01/02/2011 To: 01/02/2014Contact Details Res. Number: B-35A Mobile Number: 8010572703 Education DetailsHighest Educational QualificationPlease ensure copy of degree certificate and mark sheet are attachedName of the University Indira Gandhi National Open UniversityCollege 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 - 800001From 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 DetailsDetails of current / latest employer(In descending order covering last 5 years) Company Position Held Delivery Module Lead Name: (1) Mphasis Limited & Department EMSBUAddress (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 developmentLast 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 ITAddress (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 Agency Details (if temporary or contractual)Responsibilities: Designing and CodingLast 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 TechnologyAddress (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 ArchitectTo: 01/02/2013 Off no. Ext: Cell no. 8527698429 Res no. Whether employment is of permanent or temporary nature -  Permanent  Temporary Agency Details (if temporary or contractual)Responsibilities: Last salary drawn Reason(s) for Leaving:CTC : 32248(Rs.) per month For career growth Gross : per month Net : 32248(Rs.) per month** Fill in as much detail as possible and attach all documents. 8 Details of Previous Employer (4) Company Position Held Name: & DepartmentAddress (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 Agency Details (if temporary or contractual)Responsibilities: Last salary drawn Reason(s) for Leaving:CTC : per month Gross : per month Net : per month** Fill in as much detail as possible and attach all documents. 9 GAPSPlease account for all gaps in employment during the last five years.From To Reason: From To Reason: From To Reason: 10 Letter of AuthorizationTo whom it may concernI 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 Verification1. 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 CertificateFor 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 CardSecondary 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 StatementFor 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 StayOriginal 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.12

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