Candidate Declaration Form

VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

Instructions: Please provide all the information requested in this form. Incomplete Candidate
Declaration Forms (CDFs) will be returned. All supporting documents must accompany this form.
Photocopies must be legible. We have included a checklist to assist you to complete your
application comprehensively.

PERSONAL DETAILS

Full Name (First/Middle/Last): Ummar khan A _

Fathers Name/Husband’s Name: Athaulla Khan

Date of birth (DD/MM/YY): 30/07/1989 Contact Number: 7019354505 Nationality: Indian _

Passport Number: L5992806 Date of issue: 07/11/2013 Date of expiry: 06/11/2023 _

PAN Number: ACDPU1033A _ Blood Group: ‘O’ +ve

Personal email id: ummar.khan30@gmail.com _ DL number: KA0120120004396

Voter ID number: UHN6579817 _

Change of Name if Applicable

Former Name/Maiden Name : Date

of Name Change :

Current Address Permanent Address

Door No/Street: 150/1, 7th cross, 21st main, sector 1, Door No/Street: 150/1, 7th cross, 21st main, sector
HSR layout 1,HSR layout
City: Bangalore _ City: Bangalore _
State: Karnataka State: Karnataka
Pin: 560102 Pin: 560102
Landmark: BMTC Bus Depot 25 _ Landmark: BMTC Bus Depot 25
Period of stay: 5 years Period of stay: 5 years
Landline/Mobile No. 7019354505 _ Landline/Mobile No. 7019354505 _
Is your residence own or a rented place? OWN Is your residence own or a rented place? OWN
If rented, please provide details of the Landlord If rented, please provide details of the Landlord
Name: _ Name: _
Address: Address:
City: City:
State: _ State: _
Pin: Pin:
Landline/Mobile No. _ Landline/Mobile No. _

Proof of Address: (Photocopy of Passport / Last Paid Land Line/Mobile Phone Bill/ Bank Account Statement/
Rent Agreement Copy/Driving License/ National Identity Cards)

For Internal Use Only

VFG ID: (To be entered by Verifacts personnel only)
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 Candidate Declaration Form
VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

EDUCATION DETAILS

Client Requirements
Highest Graduation * Post Graduation
Name of the Course M.TECH
Student ID No/Enrolment No 1PI11MSE13 Duration of Study 2 YERAS
Division/Class DISTINCTION Degree Obtained
Subject Major MANUFACTURING SCIENCE Course Type (Regular/Distance) REGULAR
Name of University VISVESWARAYA TECHNOLOGICAL UNIVERSITY
Name of College/Study Centre PESIT
Address of Institution Pes Institute Of Technology & Management, Banashankari 3rd Stage, Bangalore
City: BANGALORE State: KARNATAKA
Pin: 560085 :(Landline)
: (Email ID)

Note: Please attach legible photocopies of the following documents relevant to the entries above
*Interns can mention the course they are currently pursuing

1) Mark sheets of all semesters/years 2) Degree Certificates, FRONT and BACK

3) Provisional Certificate 4) School Leaving Certificate

EMPLOYMENT
NOTE: There are two categories in each form. Please provide information under the relevant Employment Category.

Immediate Previous Employment

PERMANENT EMPLOYMENT
Delta Power solution (I) PVT LTD
Name of Company
Where were you employed?  Registered Corporate Office  Branch Office (YES)

Company Address Door No/Street 87A, 6th cross, E city phase 1, Doddatuguru village, begur hobli
(Where you were employed) City Bangalore State Karnataka

Pin 560100  (Landline)

May/2015 to Jan/2019
Period of employment Employee Code
Assistant manager 685000/Annum
Designation Remuneration
Research and Development MWP Dept Director MWP Dept
Department Reported to
Director
Supervisor’s Designation  (Email Id)
Fulltime preparation for UPSC
Reason for Leaving
CONTRACTUAL EMPLOYMENT

Company Name

Company Address Door No/Street

City State
Company Contact Person  (Email Id)
 Candidate Declaration Form
VFG/HR/ CDF Ver. No. 3 W.E.F: 16/FEB/2016

Assistant manager
Designation  (Landline)
State you reason for leaving Fulltime preparation for UPSC

Can a reference be taken now?  Yes  No

If No, when can it be taken?

Note: Please attach legible Photo copies of the following documents relevant to the entries above
Appointment Letter, Salary slips and Release Letter / Service certificate

Authorization/ Declaration and Undertaking

If employed by Think & Learn Pvt Ltd, I agree to provide copies of all relevant certificates. I understand that employment
with Think & Learn Pvt Ltd is governed by their employment policies as applicable, including satisfactory information from
background checks.

I hereby certify that all information provided herein, is true and complete to the best of my knowledge and belief. I authorize
Think & Learn Pvt Ltd and its representative to authenticate information I have provided in my resume and this Candidate
Declaration Form (CDF). To conduct enquiries as may be necessary at the company’s discretion, I authorize all who may
have information relevant to this enquiry to disclose it to Think & Learn Pvt Ltd and/or its representative. I release all
concerned from any liability on account of such disclosures.

I also declare that the information provided by me in my resume and application for employment at Think & Learn Pvt Ltd
and its representative is authentic and I am liable for all inaccuracies and omissions.

I promise to extend total co-operation and provide relevant documents required.

Full Name of the Candidate: Ummar Khan A Signature of the Candidate

Place: Bangalore

Date: 30/07/1989

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