NET CONNECT PVT. LTD.

PERSONAL INFORMATION FORM (To be filled in Block Letters)

Please affix your Photograph here

Employee Code: __________________ Name: RAHUL KUMAR NANDEKAR Date of Joining 21-06-2012 Client: IBM BHARTI AIRTEL Location: CENTER POINT BHOPAL Reporting Manager: _____________________ Department: _________________________ Designation: NETWORK ENGINEER Date of Birth: 14-08-1982 Place of Birth (with State): CHHINDWARA (M.P) Mothers Name: ANNU NANDEKAR Fathers Name: M.S.NANDEKAR Nationality: INDIAN Sex: MALE

Marital Status: SINGLE Date of Marriage: NA Mother Tongue: HINDI Blood Group: B+

Address
Address line 1 Address line 2 City & State Phone & Fax Pager/ Mobile

Present
SNEH NAGAR BARKUHI POST CHANDAMETTA CHHINDWARA (M.P)

Permanent
SNEH NAGAR BARKUHI POST CHANDAMETTA CHHINDWARA (M.P)

99814-17327

99814-17327

E-Mail: rahul.nandekar@gmail.com Pan Number: AIVPN3131E ICICI Account No.: _________________________________________________

Passport Details:
Passport No. Place of issue Issued on Valid up to ECNR (Y) Other details

Weight & Height: 55 & 5.4

Identification Marks: STRECH MARK IN RIGHT LAG

Family details:
Name
Relationship FATHER MOTHER BROTHER

DOB

Qualification

Occupation (Desig./ company)

Income

M S NANDEKAR ANNU NANDEKAR SURENDRA NANDEKAR

Computer Literacy:
Area of Proficiency Institute ( If any )

Language Proficiency:
Language Read Write Speak Certificates ( If any )

HINDI ENGLISH

Y Y

Y Y

Y Y

Professional Membership, Achievements:

Extra Curricular Activities / Achievements:

Academic Qualification (Latest One first) (Including certificates & short term courses):
Degree Subject College/Univ/B oard Year of Passing % of Marks Remarks

Training Details (Mention Important Trainings):

Name of Course Title of Training Training Agency Year Duration

Experience Details:
Total Experience _______________Year ______________Months ___________

Experience (Chronologically starting with the latest):

Organization Year From -- To -Position Held Job Responsibility Designation of Immediate Superior Gross Salary Drawn

Background Verification Details (Last Employer):

Name Reporting Manager HR Manager Designation Contact Number Email ID

Emergency Contact : Name: ________________________________________________________________ Address:_______________________________________________________________ ______________________________________________________________________ Ph No: ________________________________________________________________

Nomination Details (for PF/Insurance, etc.):

Nominee Name Address Relationship Age

References:
S.No.
1 2

Name

Designation

Department

Co. Name

Contact No.

I hereby declare that the information provided above is true to the best of my knowledge.

_______________
Signature

Date: _____________

Checklist of Joining Formalities: (To be filled by HR) Particulars

1. 4 Passport size Photographs 2. Copy of Resignation Approval mail of Previous Company 3. Relieving Letter of Previous Company 4. Salary Certificate / Last Pay slip of Previous Company 5. Offer Letter of Previous Company 6. Educational Certificates and Technical courses (If any) 7. EPF Declaration Form 8. ESI Declaration Form (If applicable) 9. Age Proof 10.Address Proof 11.PAN Card Copy 12.Offer letter acknowledgement copy

Please Tick