ANNEXURE 1

Information Release Form

IherebyauthorizeCapgeminiIndiaPrivateLimitedoranyofitAffiliates(orathirdpartyagent
appointedbytheCompany)tocontactanyformeremployersasindicatedaboveandcarryoutall
BackgroundChecksnotrestrictedtoeducationandemploymentbeforeandduringtheperiodof
employment.Iauthorizeformeremployers,agencies,educationalinstitutesetc.toreleaseany
informationpertainingtomyemployment/educationandIreleasethemfromanyliabilityin
doingso.
I confirm thatmyappointmentisbasedontheinformationfurnishedbymeinmyemployment

application and all further declarations and undertakings. Hence, any false statement or
informationfurnishedasaboveand/orfurnishedduringtheperiodofmyemployment,willresult
inactionbasedoncompanypolicyincludingdismissalwithoutnotice.

First Name
Date

Middle Name
D

Last Name
M

Signature

Note: Please mention current date, not date of birth.