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
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 :
EXAMINATION GRADE/
YEAR OF PASSING NAME & ADDRESS MAIN UNIVERSITY OR
CLASS OR
PASSED MEDIUM OF INSTRUCTION OF INSTITUTION SUBJECT BOARD
DIVISION
COMPUTER SKILLS
-· NAME OF THE PERCENTAGE OBTAINED
LANGUAGES KNOWN INSTITUTION & YEAR OF PASSING
LUNCH
CONVEYANCE
INCENTIVE
ANY OTHERSPECIFY
BONUS
LT.A.
MEDICAL
P.A.
ANY OTHERSPECIFY
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 USYES /
NO
IHEREBY AUTHOR IZE SHRIRAM FINANCE LIMITED (OR A THIRD AGENT APPOINTED BY THE COMPANY) TO CONTACT
ANY FORMER EMPLOYERS AS INDICATED ABOVE AND CARRY OUT ALL BACKGROUND CHECKS NOT RESTR ICTED
TO EDUCATION AND EMPLOYMENT DEEMED APPROPRIATED THROUGH THIS SELECTION PROCEDURE. I AUTHORIZE
FORMER EMPLOYERS, AGENC IES, EDUCATIONAL INSTITUTES ETC. TO RELEASE ANY INFORMATION PERTAINING TO
MY EMPLOYMENT/EDUCATIO N AND I RELEASE THEM FROMANYLIABILITY INDOING SO.
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 LI MI TE D
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
photograph
of the
member
Scheme ...............................................................................................................
Name of the Life to be Assured, whois
the Employee of the Organization
Nominee Relationship with the life assured Nominees Age last birthday
Date of Birth
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 disability ormedical Yes No
condition such as but not limited to high cholesterol high blood pressure, chest
pain, heart attack or any other heart condition stroke, transientischemIc attack or any
other cerebrovascular disease; diabetes or any otherendocrinel disease; kidney disease;
HIV / AIDS or AIDS related complex; anycancer or tumor; asthma or any other
respiratory disease; any mental ornervous disease; hepatitis or any other liver disease;
blood disorders; digestiveand 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 morethan 7
Yes No
consecutive days to treat an illness or disease?
3. Have you within the last 5 years consulted any medical practitioner for anycondition Yes No
other than minor impairment such as common cough or cold?
It is important to be as accurate as possible when answering the declaration of good health, as inaccurate
information may negatively impact payments at the claims stage.
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 thecontents
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 theMember and he/she has
confirmed that they are correct.
Place : Name :
Name : Signature :