SFL-Employment Form
SFL-Employment Form
NAME
DESIGNATION
TO WHOM REPORTED
DATE
SIGNATURE OF EMPLOYEE
Sir
code............................hereby confirm that I have read and understood all the contents of Disciplinary
Rules and Proceedings and undertake to abide by all the rules and regulations of the Company.
Thanking you
Yours Sincerely,
PERSONAL DATA
FULLNAME IN BLOCK LETTERS
MR./MRS./MISS
(FIRST NAME) (MIDDLE NAME) (SURNAME)
ADDRESS ADDRESS
DATE OF BIRTH PLACE & STATE OF BIRTH BLOOD GROUP PAN NO.: AADHAR NO.
HEIGHT (ems) WEIGHT (kg) MARITIAL STATUS PHYSICAL DISABILITY, IFANY NATIONALITY RELIGION
'
MOTHER TONGUE :
OTHER LANGUAGES 1
MOTHER
HUSBAND
WIFE
CHILDREN ·
BROTHER/SISTER :
COMPUTER SKILLS
-· NAME OF THE PERCENTAGE
LANGUAGES KNOWN INSTITUTION & YEAR OF PASSING OBTAINED
INCENTIVE
ANY OTHER
SPECIFY
BONUS
LT.A.
MEDICAL
P.A.
ANY OTHER
SPECIFY
GRANDTOTAL
DO YOU HAVE ANY FRIEND I RELATIVES EMPLOYED IN OUR COMPANY OR GROUP OF COMPANIES
? IF ANY, GIVE DETA ILS
NAME RELATIONSHIP
PLEASE MENTION FRANKLY AND BRIEFLY YOUR STRONG AND WEAK POINTS IN RELATION TO
YOUR JOB
STRENGTH:
WEAKNESS :
CAN WE MAKE A REFERENCE TO YOUR PREVIOUS EMPLOYERS, IF SELECTED BY US AND AFTER YOU JOIN US
YES / NO
NAME
OCCUPAT ION ADDR ESS
IALSO CERTIFY THAT THE STATEMENT'S MADE BY ME ARE TRUE, COMPLETE AND CORRECT, IAGREE THAT IN
CASE THE COMPANY FINDS AT ANY TIME INFORMATIONS GIVEN BY ME IN THISAPPLICATIONARE NOT TRUE OR
COMPLETE, THE COMPANY WILL HAVE THE RIGHT TO TERMINATE MY EMPLOYMENT WITHOUT NOTICE. IF
SELECTED, IALSO UNDERTAKETOABIDEBYALLTHE RULESAND REGULATIONS OFTHE COMPANY.
--------
NAME DATE
SHRIRAM FINANCE LIMITED
EMPLOYEE
NAME :-
EMP. CODE
:-
ADDRESS (OFFICE) :-
RES.ADDRESS: -
BLOOD GROUP :-
CONTACT NO :-
DATE OFJOINING :-
DATE :-
PLACE :-
Signature
FORM F
[See sub-rule (1) of rule 6]
Nomination
To,
Shriram Finance Ltd.
1. Shri. Shrimati/Kumari(Name in full here)
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 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 Cl. (h) of Sec. 2 of the Payment of Gratuity
Act, 1972.
3. I hereby declare that I have no family within the meaning of Cl. (h) of Sec.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 Cl. (h) of Sec.2 of the said Act.
6. Nomination made herein invalidates my previous nomination.
Proportion by
Sr.No Relationship with Age of
Name in full with full address of nominee(s) which the gratuity
. the employee nominee
will be shared
1
2
3
STATEMENT
Place……………… Signature/Thumb-impression
Date………………. of the employee.
DECLARATION BY WITNESSES
Nomination signed/thumb-impressed before me.
Sr.No. Name in full and full address of: Signature of witnesses:
1
2
Place………………..
Date………………..
Certificate 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 Name and address of the establishment Or rubber stamp thereof
Date……………..
Received the duplicate copy of nomination in Form f filed by me and duly certified by the employer.
Date………………. Signature of the
employer.
Paste
recent
photograp
h of the
member
Scheme ...............................................................................................................
Name of the Life to be Assured,
who is the Employee of the
Organization
Name of the Nominee
Nominee Relationship with the life Nominees Age last
assured birthday
Date of Birth
Date of Joining the Organization
Please Tick () For Either Yes or No - Otherwise The Application Will Be Invalid
1. Have you ever been diagnosed with or received treatment for any Yes No
disability or medical condition such as but not limited to high
cholesterol high blood pressure, chest pain, heart attack or any
other heart condition stroke, transient ischemIc attack or any
other cerebrovascular disease; diabetes or any other endocrinel
disease; kidney disease; HIV / AIDS or AIDS related complex; any
cancer or tumor; asthma or any other respiratory disease; any
mental or nervous disease; hepatitis or any other liver disease;
blood disorders; digestive and bowel disorders; paraplegia or any
other disorder of the bones, spine or
muscle?
2. Have you within the last 5 years taken any form of
medication for more than 7 consecutive days to treat an Yes No
illness or disease?
3. Have you within the last 5 years consulted any medical
Yes No
practitioner for any condition other than minor impairment such
as common cough or cold?
In case the answer is "Yes" to any of the above questions full details may be
provided in the section below. Shriram Life Insurance Company Limited will
consider these details when the decision about extending cover is taken.
I hereby declare that, the above information is true to the best of my knowledge
and belief and if any information is found to be incorrect, the Cover under the
said policy can be cancelled by the Insurer.
I have explained the contents of this form to the Member and done my best to
ensure that the contents have been fully understood by the Member and have
accurately recorded the Member responses to the information sought by this DGH
form and I have read the responses back to the Member and he/she has confirmed
that they are correct.
Place : Name :
Name : Signature :